Healthcare Provider Details

I. General information

NPI: 1669700241
Provider Name (Legal Business Name): LANIER INTERVENTIONAL PAIN CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2009
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2335 LIMESTONE OVERLOOK
GAINESVILLE GA
30501-7443
US

IV. Provider business mailing address

2335 LIMESTONE OVERLOOK
GAINESVILLE GA
30501-7443
US

V. Phone/Fax

Practice location:
  • Phone: 770-297-0356
  • Fax: 770-297-7564
Mailing address:
  • Phone: 770-297-0356
  • Fax: 770-297-7564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN L. GIVOGRE
Title or Position: MANAGING MEMBER
Credential: M.D.
Phone: 770-297-0356