Spine Specialists of Atlanta, LLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

79267 Issued in GA

Legal business name

SPINE SPECIALISTS OF ATLANTA, LLC

Practice address

1462 Montreal Rd. Suite 212
Tucker, GA 30084-6929

Phone

(770) 934-4233

Fax

(678) 395-4585

NPI assigned

May 15, 2018

Organization subpart

No

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

Authorized official

Name

Mr. Dana Gene Piccirillo

Title

Owner

Phone

(770) 934-4233

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1526342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1526342400000",
    "number": "1114417250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1462 MONTREAL RD. SUITE 212",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300846929",
            "telephone_number": "770-934-4233",
            "fax_number": "678-395-4585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1462 MONTREAL RD. SUITE 212",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300846929",
            "telephone_number": "770-934-4233",
            "fax_number": "678-395-4585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPINE SPECIALISTS OF ATLANTA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-15",
        "last_updated": "2018-05-15",
        "status": "A",
        "authorized_official_last_name": "PICCIRILLO",
        "authorized_official_first_name": "DANA",
        "authorized_official_middle_name": "GENE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-934-4233",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "GA",
            "license": "79267",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in Tucker, GA
• Providers in Tucker, GA by specialty
• General Practice Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2018; 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.