MEDICARE: SOUTHEASTERN PAIN SPECIALISTS, P.C.

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	207LP2900X	Pain Medicine (Anesthesiology) Physician

General Provider Information

NPI Number	:	1942357983
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHEASTERN PAIN SPECIALISTS, P.C.

Provider Business Mailing Address
First Line	:	1140 HAMMOND DRIVE
Second Line	:	D 4190
City	:	ATLANTA
State	:	GA
Zip	:	30328-5331
Country	:	US
Telephone Number	:	770-558-8501
Fax Number	:	770-558-8512

Provider Business Practice Location Address
First Line	:	1140 HAMMOND DRIVE
Second Line	:	D 4190
City	:	ATLANTA
State	:	GA
Zip	:	30328-5331
Country	:	US
Telephone Number	:	770-558-8501
Fax Number	:	770-558-8512

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. DONALD E KIRK
Credential	:
Telephone Number	:	770-558-8501

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	06/16/2010

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