MEDICARE: PAIN & PALLIATIVE CARE CENTER OF ATLANTA

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	207LH0002X	Hospice and Palliative Medicine (Anesthesiology) Physician	057977	GA

General Provider Information

NPI Number	:	1922387687
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAIN & PALLIATIVE CARE CENTER OF ATLANTA

Provider Business Mailing Address
First Line	:	2624 SAINT PAUL DR
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331
Country	:	US
Telephone Number	:	678-596-2227
Fax Number	:	770-603-1122

Provider Business Practice Location Address
First Line	:	2624 SAINT PAUL DR
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331
Country	:	US
Telephone Number	:	678-596-2227
Fax Number	:	770-603-1122

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KEVIN D GOODLOW
Credential	:	MD
Telephone Number	:	678-596-2227

Provider Enumeration Date	:	08/12/2011
Last Update Date	:	08/12/2011

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