Provider Demographics
NPI:1578938395
Name:HANOWELL SPINE CLINIC LLC
Entity type:Organization
Organization Name:HANOWELL SPINE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JADE
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-787-3550
Mailing Address - Street 1:4142 MILL ST NE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-2540
Mailing Address - Country:US
Mailing Address - Phone:770-787-3550
Mailing Address - Fax:770-787-2304
Practice Address - Street 1:4142 MILL ST NE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2540
Practice Address - Country:US
Practice Address - Phone:770-225-0098
Practice Address - Fax:770-787-2304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-04
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADW7010Medicare PIN
GA202G706110Medicare PIN