Healthcare Provider Details

I. General information

NPI: 1790854206
Provider Name (Legal Business Name): INTERVENTIONAL PAIN INSTITUTE, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

378 W CHESTNUT ST SUITE 105
WASHINGTON PA
15301-4659
US

IV. Provider business mailing address

804 SCOTT NIXON MEMORIAL DR
AUGUSTA GA
30907-2464
US

V. Phone/Fax

Practice location:
  • Phone: 724-222-5471
  • Fax: 724-222-0305
Mailing address:
  • Phone: 800-394-4445
  • Fax: 706-955-0735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number StatePA

VIII. Authorized Official

Name: WILLIE MICHAEL FUSSELL
Title or Position: OWNER
Credential: DO
Phone: 724-228-1414