Healthcare Provider Details

I. General information

NPI: 1912388976
Provider Name (Legal Business Name): ROSWELL PAIN SURGICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2015
Last Update Date: 06/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 UPPER HEMBREE RD SUITE B
ROSWELL GA
30076-0927
US

IV. Provider business mailing address

1300 UPPER HEMBREE RD SUITE B
ROSWELL GA
30076-0927
US

V. Phone/Fax

Practice location:
  • Phone: 678-736-7680
  • Fax: 888-537-5362
Mailing address:
  • Phone: 678-736-7680
  • Fax:

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. DAMON CHRISTIAN KIMES SR.
Title or Position: OWNER
Credential: MD
Phone: 678-736-7680