1497858971 NPI number — PAIN SOLUTIONS TREATMENT CENTERS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497858971 NPI number — PAIN SOLUTIONS TREATMENT CENTERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAIN SOLUTIONS TREATMENT CENTERS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GEORGIA PAIN CLINIC
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497858971
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4779
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARIETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30061-4779
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-590-1078
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 TOWER RD NE
Provider Second Line Business Practice Location Address:
SUITE 350
Provider Business Practice Location Address City Name:
MARIETTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30060-9415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-590-1078
Provider Business Practice Location Address Fax Number:
770-422-7306
Provider Enumeration Date:
09/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HAWKINS
Authorized Official First Name:
GAYLE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF OPERATIONS
Authorized Official Telephone Number:
770-590-1078

Provider Taxonomy Codes

  • Taxonomy code: 208VP0014X , with the licence number:  00049726 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com