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General NPI Number Information
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NPI Number | 1083246581
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Entity Type | Organization
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Legal Business Name | GEORGIA NEURO PAIN THERAPY
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Dates
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Enumeration Date | 02/12/2020
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Last Update Date | 02/25/2022
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Provider Practice Location Address
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Address Line | 4330 S LEE ST STE 600B
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City | BUFORD
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State | GA
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Zip | 30518-6197
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Country | US
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Telephone | 770-410-9116
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Fax |
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Provider Business Mailing Address
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Address Line | 4330 S LEE ST STE 600B
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City | BUFORD
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State | GA
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Zip | 30518-6197
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Country | US
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Telephone | 770-410-9116
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Fax |
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Authorized Official
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Title or Position | RN
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Name | MR. RANDALL KURT AMOS
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Credential | RN
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Telephone | 770-410-9116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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