MEDICARE: LASER SPINE & PAIN CENTERS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP3300X	Pain Clinic/Center

General Provider Information

NPI Number	:	1346763190
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LASER SPINE & PAIN CENTERS LLC

Provider Business Mailing Address
First Line	:	403 PERMIAN WAY STE C
Second Line	:
City	:	VILLA RICA
State	:	GA
Zip	:	30180-3252
Country	:	US
Telephone Number	:	770-627-7246
Fax Number	:

Provider Business Practice Location Address
First Line	:	403 PERMIAN WAY STE C
Second Line	:
City	:	VILLA RICA
State	:	GA
Zip	:	30180-3252
Country	:	US
Telephone Number	:	770-627-7246
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	V.K. PUPPALA
Credential	:	MD
Telephone Number	:	770-627-7246

Provider Enumeration Date	:	07/24/2017
Last Update Date	:	08/08/2025

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