Provider Type Icon

BACK TO LIFE MEDICAL GROUP LLC NPI 1396987152


NPI Information

NPI: 1396987152
Provider Name: BACK TO LIFE MEDICAL GROUP, LLC

Doing Business As: SPINAL MEDICAL CENTERS

Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 11D2017911

Address:
557 RIVERSTONE PKWY
SUITE 140
CANTON, GA
ZIP 30114
Phone: (770) 345-2000
Get Directions

BACK TO LIFE MEDICAL GROUP, LLC is a family medicine in Canton, GA. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. BACK TO LIFE MEDICAL GROUP, LLC NPI is 1396987152. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Spinal Medical Centers.

The provider's business location address is:

557 RIVERSTONE PKWY
SUITE 140
CANTON, GA
ZIP 30114-223
Phone: (770) 345-2000
Fax: (770) 345-4524

The provider's authorized official is Eric A Cavaciuti .
The authorized official title is Owner and has the following contact phone number (770) 345-2000.

The CLIA number assigned to this NPI record is 11D2017911 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 3/25/2009 and was last updated on 11/10/2014.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207Q00000XFamily Medicine048997GEORGIAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.