Healthcare Provider Details

I. General information

NPI: 1447529342
Provider Name (Legal Business Name): PAIN MANAGEMENT OF THE SOUTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2011
Last Update Date: 12/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3890 REDWINE RD SW SUITE 200
ATLANTA GA
30331-5582
US

IV. Provider business mailing address

3890 REDWINE RD SW SUITE 200
ATLANTA GA
30331-5582
US

V. Phone/Fax

Practice location:
  • Phone: 678-904-5499
  • Fax: 404-344-6575
Mailing address:
  • Phone: 678-904-5499
  • Fax: 404-344-6575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number057737
License Number StateGA

VIII. Authorized Official

Name: DR. PICKENS ANDREW PATTERSON III
Title or Position: OWNER
Credential: M.D.
Phone: 678-904-5499