Organization
GEORGIA BRAIN AND SPINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AMOS O DARE M.D. (MEDICAL DIRECTOR)
(404) 418-0192
Entity
Organization
Contact information
Practice address
2107 N DECATUR RD, UNIT 448, DECATUR, GA 30033-5305
(404) 418-0192
(844) 360-9946
Mailing address
2107 N DECATUR RD, UNIT 448, DECATUR, GA 30033-5305
(404) 418-0192
(844) 360-9946
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
64353
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
64353
MEDICAL LICENSE
GA
Enumeration date
03/14/2017
Last updated
03/14/2017
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