Organization Active NPI

Craniospinal Institute of Georgia

  • Specialist
  • Marietta, GA
National Provider Identifier
1508926635
Registry record updated Jul 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
CRANIOSPINAL INSTITUTE OF GEORGIA
Practice address
3901 Roswell Rd Ste 225
Marietta, GA 30062-8816
Phone
(770) 424-2025
Fax
(770) 425-1789
NPI assigned
Dec 11, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2025

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

Authorized official

Name
Daniel W Moore, MDNPI 1710047832
Title
Ceo
Phone
(770) 424-2025

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

3901 Roswell Rd Ste 225
Marietta, GA 30062-8816

Mailing address

3901 Roswell Rd Ste 225
Marietta, GA 30062-8816
Phone (770) 424-2025

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050922000279 GA Part B Supplier - Clinic/Group Practice 8921032632 Receives reassigned benefits from 1 practitioner
Practice locations: Marietta, GA

National Provider Directory

National Provider Directory

Locations

790 Church St NE
Ste 330
Marietta, GA 30060
Phone (770) 424-2025

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751328000000",
    "number": "1508926635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3901 ROSWELL RD STE 225",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300628816",
            "telephone_number": "770-424-2025",
            "fax_number": "770-425-1789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3901 ROSWELL RD STE 225",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300628816",
            "telephone_number": "770-424-2025",
            "fax_number": "770-425-1789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRANIOSPINAL INSTITUTE OF GEORGIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-11",
        "last_updated": "2025-07-01",
        "certification_date": "2025-07-01",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "770-424-2025",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.