Healthcare Provider Details

I. General information

NPI: 1952336133
Provider Name (Legal Business Name): CENTER FOR SPINE & PAIN MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1413 CHATTANOOGA AVE
DALTON GA
30720-2631
US

IV. Provider business mailing address

1413 CHATTANOOGA AVE
DALTON GA
30720-2631
US

V. Phone/Fax

Practice location:
  • Phone: 706-279-2635
  • Fax: 706-279-2679
Mailing address:
  • Phone: 706-279-2635
  • Fax: 706-279-2679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MR. SULEMAN SOHANI
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 706-279-2635