Healthcare Provider Details

I. General information

NPI: 1457770547
Provider Name (Legal Business Name): PHYSICIANS INSTITUTE FOR PAIN MANAGEMENT ASC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2014
Last Update Date: 04/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3312 N OAK STREET EXT STE F
VALDOSTA GA
31605-1065
US

IV. Provider business mailing address

3312 N OAK ST EXT SUITE F
VALDOSTA GA
31602
US

V. Phone/Fax

Practice location:
  • Phone: 229-247-3300
  • Fax:
Mailing address:
  • Phone: 229-247-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number33806
License Number StateGA

VIII. Authorized Official

Name: DR. JAMES H CAMPAGNA
Title or Position: MD/OWNER
Credential: MD
Phone: 229-247-3300