Organization
GEORGIA SPINE & NEUROSURGERY CENTER LLC
Active
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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