Healthcare Provider Details

I. General information

NPI: 1861765109
Provider Name (Legal Business Name): URGENT PAIN MANAGEMENT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2012
Last Update Date: 06/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 MACY DR
ROSWELL GA
30076-6349
US

IV. Provider business mailing address

106 AUGUSTA DR
MCDONOUGH GA
30253-4267
US

V. Phone/Fax

Practice location:
  • Phone: 678-878-3335
  • Fax: 788-783-3426
Mailing address:
  • Phone: 404-402-0773
  • Fax: 770-507-7559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: FRANCIS K ACQUAH
Title or Position: PRESIDENT/CEO
Credential: MD
Phone: 404-402-0773