South Atlanta Spine and Joint Center LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CHIR004974 Issued in GA

Legal business name

SOUTH ATLANTA SPINE AND JOINT CENTER LLC

Practice address

541 Forest Pkwy Ste 14
Forest Park, GA 30297-6110

Phone

(877) 495-7773

Fax

(877) 292-4848

NPI assigned

Dec 15, 2016

Last updated

Jun 14, 2022By the provider in NPPES

Organization subpart

Yes

Parent organization

PHENIX CITY SPINE AND JOINT CENTERAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Stephen B Cooper, DC, FACMUAP

Title

Owner/Provider

Phone

(774) 957-7738

Specialties & licenses 2

Addresses

Other identifiers 1

Part of

Phenix City Spine Joint CT

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kanksha Patel, DC

  • Chiropractor
  • Forest Park, GA
  • NPI 1023830189
  NPD (past)
• Ian David Porter, DC

  • Chiropractor
  • Riverdale, GA
  • NPI 1952071607
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1481760000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655164800000",
    "number": "1073057626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "541 FOREST PKWY",
            "address_2": "SUITE 14",
            "city": "FOREST PARK",
            "state": "GA",
            "postal_code": "302976144",
            "telephone_number": "404-431-9011",
            "fax_number": "877-292-4848"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "541 FOREST PKWY STE 14",
            "city": "FOREST PARK",
            "state": "GA",
            "postal_code": "302976110",
            "telephone_number": "877-495-7773",
            "fax_number": "877-292-4848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH ATLANTA SPINE AND JOINT CENTER LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PHENIX CITY SPINE AND JOINT CENTER",
        "enumeration_date": "2016-12-15",
        "last_updated": "2022-06-14",
        "certification_date": "2022-06-14",
        "status": "A",
        "authorized_official_last_name": "COOPER",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "774-957-7738",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC, FACMUAP"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "GA",
            "license": "CHIR004974",
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "GA",
            "license": "CHIR009021",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF GEORGIA",
            "identifier": "CHIR004974",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Thomas Wortham Simmons Jr., R.PH.
• Ali Malik Smith, PHARM D
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• Southside Medical Center, Inc (Southside Medical Center SBHC at Huie Elementary School)
• Southside Medical Center, Inc.

• Chiropractor in Forest Park, GA
• Providers in Forest Park, GA by specialty
• Chiropractor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.