Healthcare Provider Details

I. General information

NPI: 1821047069
Provider Name (Legal Business Name): THE HEMLOCK PAIN CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2006
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 PRESTON COURT SUITE 103
MACON GA
31210-5771
US

IV. Provider business mailing address

101 PRESTON COURT SUITE 103
MACON GA
31210-5771
US

V. Phone/Fax

Practice location:
  • Phone: 478-745-2385
  • Fax: 478-745-1225
Mailing address:
  • Phone: 478-745-2385
  • Fax: 478-745-1225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateGA

VIII. Authorized Official

Name: STEPHEN N. TAFOR
Title or Position: PRESIDENT
Credential: MD
Phone: 478-745-2385