Healthcare Provider Details

I. General information

NPI: 1518012004
Provider Name (Legal Business Name): THE INTERVENTIONAL SPINE AND PAIN MANAGEMENT CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1388 WELLBROOK CIR NE
CONYERS GA
30012-3872
US

IV. Provider business mailing address

3390 PEACHTREE RD NE SUITE 1500
ATLANTA GA
30326-1157
US

V. Phone/Fax

Practice location:
  • Phone: 404-920-4950
  • Fax: 404-920-4959
Mailing address:
  • Phone: 770-929-9033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. ERIN SHERROD
Title or Position: MANAGER
Credential:
Phone: 770-929-9033