Healthcare Provider Details

I. General information

NPI: 1942250865
Provider Name (Legal Business Name): PAIN CONSULTANTS OF ATLANTA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 09/25/2020
Certification Date: 09/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 PEACHTREE ST NW STE 750
ATLANTA GA
30309-2530
US

IV. Provider business mailing address

1233 HIGHWAY 54 W STE 207
FAYETTEVILLE GA
30214-4542
US

V. Phone/Fax

Practice location:
  • Phone: 404-351-7654
  • Fax: 678-904-5439
Mailing address:
  • Phone: 404-351-7654
  • Fax: 404-609-7605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ALMA ROMAN
Title or Position: MANAGER OF OPERATIONS/CREDENTIALING
Credential:
Phone: 404-354-1525