NPIMap

Organization Active NPI

Georgia Brain and Spine LLC

  • Specialist
  • Decatur, GA
National Provider Identifier
1629519343
Registry record updated Mar 14, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
64353 Issued in GA
Legal business name
GEORGIA BRAIN AND SPINE LLC
Practice address
2107 N Decatur Rd
Unit 448
Decatur, GA 30033-5305
Phone
(404) 418-0192
Fax
(844) 360-9946
NPI assigned
Mar 14, 2017
Last updated
Mar 14, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2017

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

Authorized official

Name
Dr. Amos O Dare, M.D.
Title
Medical Director
Phone
(404) 418-0192

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 64353 GA Primary

Addresses

Primary practice location

2107 N Decatur Rd
Unit 448
Decatur, GA 30033-5305

Mailing address

2107 N Decatur Rd
Unit 448
Decatur, GA 30033-5305
Phone (404) 418-0192

Other identifiers 1

IdentifierTypeStateIssuer
64353OtherGAMEDICAL LICENSE

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1489449600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1489449600000",
    "number": "1629519343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2107 N DECATUR RD",
            "address_2": "UNIT 448",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300335305",
            "telephone_number": "404-418-0192",
            "fax_number": "844-360-9946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2107 N DECATUR RD",
            "address_2": "UNIT 448",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300335305",
            "telephone_number": "404-418-0192",
            "fax_number": "844-360-9946"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA BRAIN AND SPINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-14",
        "last_updated": "2017-03-14",
        "status": "A",
        "authorized_official_last_name": "DARE",
        "authorized_official_first_name": "AMOS",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "404-418-0192",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "GA",
            "license": "64353",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "64353",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Decatur, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2017; 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.