Healthcare Provider Details

I. General information

NPI: 1356635965
Provider Name (Legal Business Name): SANDY SPRINGS PAIN CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2011
Last Update Date: 12/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7260 ROSWELL RD NE
SANDY SPRINGS GA
30328-1420
US

IV. Provider business mailing address

7260 ROSWELL RD NE
SANDY SPRINGS GA
30328-1420
US

V. Phone/Fax

Practice location:
  • Phone: 678-336-9065
  • Fax: 678-336-9470
Mailing address:
  • Phone: 678-336-9065
  • Fax: 678-336-9470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number023877
License Number StateGA

VIII. Authorized Official

Name: STEVEN EDSON
Title or Position: OWNER
Credential: DC
Phone: 954-661-8602