1346752854 NPI number — GEORGIA PAIN AND WELLNESS CENTER, LLC

Table of content: SARAH MARIE SZYMKOWICZ PHD (NPI 1740800200)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346752854 NPI number — GEORGIA PAIN AND WELLNESS CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GEORGIA PAIN AND WELLNESS CENTER, LLC
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:
Provider Other Organization Name Type Code:
6
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:
1346752854
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/05/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
455 PHILIP BLVD STE 140
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAWRENCEVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30046-8768
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-962-3642
Provider Business Mailing Address Fax Number:
770-962-3643

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1780 OAK RD STE A2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SNELLVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30078-2206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-962-3642
Provider Business Practice Location Address Fax Number:
770-962-3643
Provider Enumeration Date:
10/25/2017

Additional Information

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
AMIT
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
770-962-3642

Provider Taxonomy Codes

  • Taxonomy code: 208VP0014X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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