Organization
GEORGIA SPINE SPECIALISTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIGUEL A JIMENEZ MD (PRESIDENT)
(678) 838-6600
Entity
Organization
Contact information
Practice address
51 GORDON RD, SUITE 1, JASPER, GA 30143-7105
(678) 838-6600
(770) 438-1477
Mailing address
3903 SOUTH COBB DR, SUITE 105, SMYRNA, GA 30080
(678) 838-6600
(770) 438-1477
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
GA052966
GA
207XS0117X
Orthopaedic Surgery of the Spine Physician
GA052966
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
52062173007
BCBS CV ID
—
01
—
52062173008
BCBS AUSTELL ID
—
01
—
611911600
US DOL ID
—
05
—
615972752A
—
GA
05
—
615972752B
—
GA
05
—
805775515A
—
GA
01
—
GRP7885
MEDICARE GRP NUMBER
—
Enumeration date
05/21/2008
Last updated
04/17/2009
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