Healthcare Provider Details

I. General information

NPI: 1740613801
Provider Name (Legal Business Name): GEORGIA PAIN PHYSICIANS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2013
Last Update Date: 02/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 QUEEN CITY PKWY
GAINESVILLE GA
30501-4348
US

IV. Provider business mailing address

2550 WINDY HILL RD SE STE 215
MARIETTA GA
30067-8654
US

V. Phone/Fax

Practice location:
  • Phone: 770-850-8464
  • Fax: 770-850-8454
Mailing address:
  • Phone: 770-850-8464
  • Fax: 770-850-9727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT E WINDSOR JR.
Title or Position: MD/ OWNER
Credential:
Phone: 770-850-8464