Healthcare Provider Details

I. General information

NPI: 1902769912
Provider Name (Legal Business Name): GEORGIA INTERVENTIONAL PAIN - U, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

455 PHILIP BLVD STE 140
LAWRENCEVILLE GA
30046-8768
US

IV. Provider business mailing address

1111 GLYNCO PKWY STE 26
BRUNSWICK GA
31525-7930
US

V. Phone/Fax

Practice location:
  • Phone: 770-962-3642
  • Fax: 770-962-3643
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: AMIT PATEL
Title or Position: CEO
Credential: MD
Phone: 770-962-3642