Healthcare Provider Details

I. General information

NPI: 1356629976
Provider Name (Legal Business Name): FIRST CHOICE PAIN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2011
Last Update Date: 08/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2636 MLK JR DR SW STE 12
ATLANTA GA
30311-1634
US

IV. Provider business mailing address

3665 CLUB DR STE 107
DULUTH GA
30096-1806
US

V. Phone/Fax

Practice location:
  • Phone: 404-696-2821
  • Fax: 404-696-2823
Mailing address:
  • Phone: 678-288-6550
  • Fax: 800-609-0965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: HAKELA SCALES-MILLER
Title or Position: BUSINESS MANAGER
Credential:
Phone: 770-466-7201