Legacy Center for Spinal Surgery- Riverdale LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

LEGACY CENTER FOR SPINAL SURGERY- RIVERDALE LLC

Practice address

528 Valley Hill Rd SW Ste C
Riverdale, GA 30274-2441

Phone

(770) 291-8987

NPI assigned

May 16, 2023

Organization subpart

No

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

Authorized official

Name

Dr. Said Elshihabi, MD

Title

Owner

Phone

(770) 291-8987

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Ambulatory surgical center certification: CCN 11C0001576

Legal name

Legacy Center for Spinal Surgery - Riverdale

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Apr 20, 2024

Last certification

Apr 19, 2024

Ownership / control type

Proprietary

Facility address

528 Valley Hill Road, Suite C
Riverdale, GA 30274

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1684195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701648000000",
    "number": "1992496517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 THE EXCHANGE SE STE 200",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303392022",
            "telephone_number": "770-291-8987"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "528 VALLEY HILL RD SW STE C",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302742441",
            "telephone_number": "770-291-8987"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY CENTER FOR SPINAL SURGERY- RIVERDALE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-16",
        "last_updated": "2023-12-04",
        "certification_date": "2023-12-04",
        "status": "A",
        "authorized_official_last_name": "ELSHIHABI",
        "authorized_official_first_name": "SAID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-291-8987",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Neurological Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shawn Ledford, CRNA
• Terri Lynn Ledoux, AGACNP-BC
• Charnise Lashae Lee
• Moo Hee Lee, MD
• Legacy Brain & Spine LLC
• Legacy Primary Care and Wellness
• Khemaporn Lertdetkajorn, MD
• Rodney Fitzgerald Lester Jr.
• Jennifer Leverett, PHARM.D.
• Brittany Lewis

• Ambulatory Surgical Clinic/Center in Riverdale, GA
• Providers in Riverdale, GA by specialty
• Ambulatory Surgical Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.