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General NPI Number Information
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NPI Number | 1043482391
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Entity Type | Organization
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Legal Business Name | INTERVENTIONAL PAIN MANAGEMENT OF
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Dates
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Enumeration Date | 03/27/2008
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Last Update Date | 11/19/2013
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Provider Practice Location Address
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Address Line | 500 GORDON AVE
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City | THOMASVILLE
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State | GA
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Zip | 31792-6646
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Country | US
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Telephone | 229-228-3772
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Fax |
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Provider Business Mailing Address
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Address Line | 500 GORDON AVE
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City | THOMASVILLE
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State | GA
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Zip | 31792-6646
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Country | US
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Telephone | 229-228-3772
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TIMOTHY H WARD
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Credential | MD
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Telephone | 229-228-3772
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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