Provider Demographics
NPI:1871723684
Name:GEORGIA BRAIN & SPINE CENTER
Entity type:Organization
Organization Name:GEORGIA BRAIN & SPINE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIAS
Authorized Official - Middle Name:
Authorized Official - Last Name:DAGNEW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-938-8459
Mailing Address - Street 1:11877 DOUGLAS RD
Mailing Address - Street 2:SUITE 102272
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4325
Mailing Address - Country:US
Mailing Address - Phone:678-938-8459
Mailing Address - Fax:
Practice Address - Street 1:9635 VENTANA WAY STE 201
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30022-8622
Practice Address - Country:US
Practice Address - Phone:404-446-4424
Practice Address - Fax:404-446-4424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-15
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA054606207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty