Healthcare Provider Details

I. General information

NPI: 1184946352
Provider Name (Legal Business Name): PAIN AND SPINE CONSULTANTS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2010
Last Update Date: 05/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2076 WOODRUFF RD
GREENVILLE SC
29607-5939
US

IV. Provider business mailing address

2076 WOODRUFF RD
GREENVILLE SC
29607-5939
US

V. Phone/Fax

Practice location:
  • Phone: 864-373-7246
  • Fax: 864-286-3077
Mailing address:
  • Phone: 864-373-7246
  • Fax: 864-286-3077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number23453
License Number StateSC

VIII. Authorized Official

Name: DR. AATHIRAYEN THIYAGARAJAH
Title or Position: PRESIDENT
Credential: MD
Phone: 864-373-7246