Georgia Spine & Neurosurgery Center LLC

Primary specialty

Neurological Surgery PhysicianTaxonomy code 207T00000X

License

51201 Issued in GA

Legal business name

GEORGIA SPINE & NEUROSURGERY CENTER LLC

Practice address

2675 N Decatur Rd
Suite 110
Decatur, GA 30033-6131

Phone

(404) 299-3338

Fax

(404) 299-3315

NPI assigned

Jun 4, 2007

Organization subpart

No

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

Authorized official

Name

Kaveh Khajavi, MD

Title

Owner

Phone

(404) 299-3338

Specialties & licenses 2

Addresses

Other identifiers 6

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

{
    "created_epoch": "1180915200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1360195200000",
    "number": "1760684609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2675 N DECATUR RD",
            "address_2": "SUITE 110",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300336131",
            "telephone_number": "404-299-3338",
            "fax_number": "404-299-3315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2675 N DECATUR RD",
            "address_2": "SUITE 110",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300336131",
            "telephone_number": "404-299-3338",
            "fax_number": "404-299-3315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA SPINE & NEUROSURGERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-04",
        "last_updated": "2013-02-07",
        "status": "A",
        "authorized_official_last_name": "KHAJAVI",
        "authorized_official_first_name": "KAVEH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "404-299-3338",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Neurological Surgery",
            "state": "GA",
            "license": "51201",
            "primary": true
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "GA",
            "license": "51201",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KHAJAVI NPI",
            "identifier": "1487610275",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GULLICK NPI",
            "identifier": "1306807094",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MIHELIC NPI",
            "identifier": "1093771891",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DME NPI",
            "identifier": "1972627396",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00944358B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "931766736A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Georgia Pain and Spine Institute, PC
• Georgia Pain and Wellness Center, LLC
• Georgia Professional Medical Services LLC
• Georgia Regional Hospital
• Georgia Regional Hospital Pharmacy
• Georgia Spine & Neurosurgery Center, LLC
• Georgia Urology Ambulatory Surgical Center LLC
• Georgia Urology PA
• Georgia Urology PA
• Georgia Urology PA

• Neurological Surgery Physician in Decatur, GA
• Providers in Decatur, GA by specialty
• Neurological Surgery Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2013; 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.