1952606907 NPI number — GEORGIA PAIN PHYSICIANS, PC

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 1952606907 NPI number — GEORGIA PAIN PHYSICIANS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GEORGIA PAIN PHYSICIANS, PC
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:
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:
1952606907
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/24/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2550 WINDY HILL RD SE
Provider Second Line Business Mailing Address:
SUITE 215
Provider Business Mailing Address City Name:
MARIETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30067-8665
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-850-8464
Provider Business Mailing Address Fax Number:
770-850-9727

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2550 WINDY HILL RD SE
Provider Second Line Business Practice Location Address:
SUITE 215
Provider Business Practice Location Address City Name:
MARIETTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30067-8665
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-850-8464
Provider Business Practice Location Address Fax Number:
770-850-9727
Provider Enumeration Date:
01/24/2011

Additional Information

Authorized Official

Authorized Official Last Name:
WINDSOR
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
770-850-8464

Provider Taxonomy Codes

  • Taxonomy code: 183500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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