MEDICARE: COMPREHENSIVE SPINE & PAIN, 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	208VP0000X	Pain Medicine Physician	71014	GA

General Provider Information

NPI Number	:	1811432321
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPREHENSIVE SPINE & PAIN, LLC

Provider Business Mailing Address
First Line	:	403 PERMIAN WAY STE D
Second Line	:
City	:	VILLA RICA
State	:	GA
Zip	:	30180-3226
Country	:	US
Telephone Number	:	470-827-3648
Fax Number	:	470-706-4948

Provider Business Practice Location Address
First Line	:	5505 ROSWELL RD STE 350
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-1995
Country	:	US
Telephone Number	:	470-827-3648
Fax Number	:	470-706-4948

Authorized Official
Title or Position	:	OWNER/MD
Name	:	V.K. PUPPALA
Credential	:	M.D.
Telephone Number	:	470-827-3648

Provider Enumeration Date	:	12/20/2016
Last Update Date	:	01/12/2026

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