Healthcare Provider Details

I. General information

NPI: 1487014361
Provider Name (Legal Business Name): GRIFFIN CENTER FOR PAIN AND SPINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2016
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 S 8TH ST STE 302
GRIFFIN GA
30224-4260
US

IV. Provider business mailing address

1365 ROCK QUARRY RD STE 202
STOCKBRIDGE GA
30281-5023
US

V. Phone/Fax

Practice location:
  • Phone: 770-771-6580
  • Fax: 770-771-6589
Mailing address:
  • Phone: 770-771-6580
  • Fax: 770-771-6589

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: LINDSEY ANN MATHES
Title or Position: COO
Credential: MSN, RN, CASC
Phone: 770-771-6580