Provider Demographics
NPI:1780735175
Name:THE CENTER FOR SPINE PROCEDURES, LLC
Entity type:Organization
Organization Name:THE CENTER FOR SPINE PROCEDURES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRASSO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-421-1420
Mailing Address - Street 1:335 ROSELANE ST NW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-6969
Mailing Address - Country:US
Mailing Address - Phone:770-420-4645
Mailing Address - Fax:770-234-5526
Practice Address - Street 1:335 ROSELANE ST NW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-6969
Practice Address - Country:US
Practice Address - Phone:770-420-4645
Practice Address - Fax:770-234-5526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA00056535261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========OtherTAX ID NUMBER