Healthcare Provider Details

I. General information

NPI: 1942359906
Provider Name (Legal Business Name): THE NEXUS PAIN CENTER OF COLUMBUS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7351 OLD MOON RD
COLUMBUS GA
31909-7291
US

IV. Provider business mailing address

7351 OLD MOON RD
COLUMBUS GA
31909-7291
US

V. Phone/Fax

Practice location:
  • Phone: 706-653-7000
  • Fax: 706-653-7800
Mailing address:
  • Phone: 706-653-7000
  • Fax: 706-653-7800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateGA

VIII. Authorized Official

Name: SUNG CHANG
Title or Position: OWNER
Credential: MD
Phone: 706-653-7000