Healthcare Provider Details

I. General information

NPI: 1023896255
Provider Name (Legal Business Name): SOUTH CAROLINA PAIN AND WELLNESS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2023
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 STEVENS ST STE 201
GREENVILLE SC
29605-4528
US

IV. Provider business mailing address

455 PHILIP BLVD STE 140
LAWRENCEVILLE GA
30046-8768
US

V. Phone/Fax

Practice location:
  • Phone: 770-962-3642
  • Fax:
Mailing address:
  • Phone: 770-962-3642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: AMIT S. PATEL
Title or Position: CEO
Credential: MD
Phone: 770-962-3642