PEACHTREE SPINE & PAIN PHYSICIANS, INC (NPI# 1881902575) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1881902575 |
| Entity Type | Organization |
| Organization Name | PEACHTREE SPINE & PAIN PHYSICIANS, INC |
| Other Organization Name | PEACHTREE SPINE PHYSICIANS |
| Practice Address |
711 Canton Rd Ne Ste 200 Marietta GA 30060-8949 |
| Mailing Address |
5555 Peachtree Dunwoody Rd Ne Ste 201 Atlanta GA 30342-1711 |
| Practice Telephone | 4048433323 |
| Practice Fax Number | 4045745944 |
| Mailing Telephone | 4048433323 |
| Mailing Fax Number | 4045745944 |
| Enumeration Date | 2010-09-16 |
| Last Update Date | 2010-09-16 |
| Authorized Official Name | DR. JEFFREY BENDER (PRESIDENT) |
| Authorized Official Telephone | 4048433323 |
| Authorized Official Credential | MD |
| Is Organization Subpart | Y |
| Parent Organization Name | PEACHTREE SPINE & PAIN PHYSICIANS, INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2081P2900X |
Physical Medicine & Rehabilitation Specialization: Pain Medicine |
046109 | GA | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Peachtree Spine Physicians | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336458355 | Peachtree Spine & Pain Physicians, Inc | Physical Medicine & Rehabilitation | 771 Virginia Ave, Hapeville, GA 30354-1911 | 2010-09-27 |
| 1831407535 | Peachtree Spine & Pain Physicians, Inc | Physical Medicine & Rehabilitation | 4705 Lawrenceville Hwy Nw Ste A, Lilburn, GA 30047-3667 | 2010-09-16 |
| 1043527708 | Peachtree Spine & Pain Physicians, Inc | Physical Medicine & Rehabilitation | 4255 Johns Creek Pkwy Ste C, Suwanee, GA 30024-6122 | 2010-09-01 |
| 1326355082 | Peachtree Spine & Pain Physicians, Inc | Family Medicine | 315 W Ponce De Leon Ave Ste 970, Decatur, GA 30030-2471 | 2010-09-01 |
| Street Address |
711 CANTON RD NE STE 200 |
| City | MARIETTA |
| State | GA |
| Zip Code | 30060-8949 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144845116 | Legacy Center for Spinal Surgery, LLC | Neurological Surgery | 1900 The Exchange, Ne, Suite 600, Marietta, GA 30060 | 2020-06-15 |
| 1407477193 | Michael Cynil Daniel | Counselor | 698 N Marietta, Pkwy, Marietta, GA 30060 | 2020-05-04 |
| 1285253401 | Cameron Thomas Kennelly | Student in an Organized Health Care Education/Training Program | 677 Church Street Ne Attn:gme, Marietta, GA 30060 | 2020-04-09 |
| 1922640739 | Jeremiah George Blair | Physician Assistant | 61 Whitcher St Suite 2100, Marietta, GA 30060 | 2019-10-14 |
| 1164064945 | Denise Alicia Mick | Registered Nurse | 677 Church St Wellstar Kennestone Hospital, Marietta, GA 30060 | 2019-10-12 |
| 1184283772 | Iora Health Georgia, P.C. | Internal Medicine | 280 Cobb Pkwy Se, Suite 60, Marietta, GA 30060 | 2019-06-07 |
| 1346703212 | Caitlin Virginia Mueller | Student in an Organized Health Care Education/Training Program | 677 Church Street Ne, Attn: Gme, Marietta, GA 30060 | 2019-04-08 |
| 1184187205 | Adero Francis | Student in an Organized Health Care Education/Training Program | Wellstar Kennestone Gme Internal Medicine Clinic, 833 Campbell Hill St Nw, Suite 250, Marietta, GA 30060 | 2019-04-08 |
| 1659832749 | Matthew Mozzo | Student in an Organized Health Care Education/Training Program | 677 Church Street / Lower Level, Gme Department / I.m., Marietta, GA 30060 | 2019-03-29 |
| 1245797430 | La'myia Spentz | Specialist | 109 Anderson St Ne, Suite 608, Marietta, GA 30060 | 2019-02-25 |
| Find all providers in zip 30060 | ||||
| Taxonomy Code | 2081P2900X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Physical Medicine & Rehabilitation |
| Specialization | Pain Medicine |
| A physician who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic or cancer pain in both hospital and ambulatory settings. Patient care needs may also be coordinated with other specialists. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition changed, source changed] Additional Resources: American Board of Physical Medicine and Rehabilitation, 2007. http://www.abpmr.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Physical Medicine and Rehabilitation. A subspecialty certificate was approved by the ABMS in 1999. ACGME Accredited Residency Program Requirements: Proposal under development. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679884753 | Victor Osisanya | Physical Medicine & Rehabilitation | 2550 Windy Hill Rd Se Ste 215, Ste 215, Marietta, GA 30067-8654 | 2010-06-23 |
| 1922140334 | Roman Lev Piraner | Physical Medicine & Rehabilitation | 100 Lacy St Nw Ste 150, Marietta, GA 30060-1273 | 2007-02-13 |
| 1508904715 | Marc J Kornfield Md PC | Physical Medicine & Rehabilitation | 1335 Canton Rd Ste C, Marietta, GA 30066-6053 | 2007-02-01 |
| 1609851773 | Arnold Jay Weil | Physical Medicine & Rehabilitation | 335 Roselane St Nw, Marietta, GA 30060-6969 | 2005-12-13 |
| 1316580145 | Regenerative Health Solutions Chiropractic, Nutrition, Detoxification | Physical Medicine & Rehabilitation | 3823 Roswell Rd Ste 202, Marietta, GA 30062-6278 | 2019-10-24 |
| 1730342106 | Seung Yi Chang | Physical Medicine & Rehabilitation | 2550 Windy Hill Rd Se, Ste 215, Marietta, GA 30067-8665 | 2008-07-07 |
| 1376755538 | Paul L Mefferd | Physical Medicine & Rehabilitation | 790 Church St Ne, Suite 550, Marietta, GA 30060-7282 | 2007-05-03 |
| 1053432401 | Marc Joel Kornfield | Physical Medicine & Rehabilitation | 1335 Canton Rd Ste C, Marietta, GA 30066-6053 | 2007-04-03 |
| 1235186636 | Robert E Windsor | Physical Medicine & Rehabilitation | 2550 Windy Hill Rd, Ste 215, Marietta, GA 30067 | 2006-05-30 |
| 1295710093 | Anthony Grasso | Physical Medicine & Rehabilitation | 335 Roselane St Nw, Marietta, GA 30060-6969 | 2005-12-14 |
| Find all providers in MARIETTA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.