Healthcare Provider Details

I. General information

NPI: 1275841215
Provider Name (Legal Business Name): ATLANTA SPINE AND ALTERNATIVE PAIN MANAGEMENT CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2010
Last Update Date: 03/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1938 PEACHTREE RD NW SUITE 610
ATLANTA GA
30309-1267
US

IV. Provider business mailing address

1938 PEACHTREE RD NW SUITE 610
ATLANTA GA
30309-1267
US

V. Phone/Fax

Practice location:
  • Phone: 770-333-9405
  • Fax:
Mailing address:
  • Phone: 404-355-2728
  • Fax: 404-355-2785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number056454
License Number StateGA

VIII. Authorized Official

Name: ARTENA THOMAS
Title or Position: PRACTICE MANAGER
Credential:
Phone: 404-355-2728