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Organization

GEORGIA SPINE & NEUROSURGERY CENTER LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
KAVEH KHAJAVI MD (OWNER)
(404) 299-3338
Entity
Organization

Contact information

Practice address
2675 N DECATUR RD, SUITE 110, DECATUR, GA 30033-6131
(404) 299-3338
(404) 299-3315
Mailing address
2675 N DECATUR RD, SUITE 110, DECATUR, GA 30033-6131
(404) 299-3338
(404) 299-3315

Taxonomy

Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
51201
GA
332BC3200X
Customized Equipment (DME)
51201
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00944358B
GA
01
1093771891
MIHELIC NPI
01
1306807094
GULLICK NPI
01
1487610275
KHAJAVI NPI
01
1972627396
DME NPI
05
931766736A
GA
Enumeration date
06/04/2007
Last updated
02/07/2013
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