MEDICARE: THE INTERVENTIONAL SPINE AND PAIN MANAGEMENT CENTER PC

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	208VP0014X	Interventional Pain Medicine Physician		GA

General Provider Information

NPI Number	:	1457707184
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE INTERVENTIONAL SPINE AND PAIN MANAGEMENT CENTER PC

Provider Business Mailing Address
First Line	:	3390 PEACHTREE RD NE
Second Line	:	SUITE 1500
City	:	ATLANTA
State	:	GA
Zip	:	30326-1157
Country	:	US
Telephone Number	:	404-920-4950
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 PARKBROOKE PL STE 390
Second Line	:
City	:	WOODSTOCK
State	:	GA
Zip	:	30189-7209
Country	:	US
Telephone Number	:	770-929-9033
Fax Number	:	770-929-9092

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ERIN SHERROD
Credential	:
Telephone Number	:	404-920-4950

Provider Enumeration Date	:	05/12/2016
Last Update Date	:	12/03/2024

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