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General NPI Number Information
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NPI Number | 1104775600
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Entity Type | Organization
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Legal Business Name | CONSULTANTS IN PAIN MEDICINE, LLC
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Dates
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Enumeration Date | 01/27/2026
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Last Update Date | 02/03/2026
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Provider Practice Location Address
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Address Line | 2658 US HIGHWAY 17 SOUTH
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City | RICHMOND HILL
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State | GA
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Zip | 31324-3374
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Country | US
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Telephone | 912-590-0973
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Fax | 912-590-0180
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Provider Business Mailing Address
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Address Line | 5191 FIRST COAST TECH PKWY FL 3
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City | JACKSONVILLE
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State | FL
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Zip | 32224-0609
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Country | US
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Telephone | 904-223-3321
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Fax | 904-223-2169
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | ALICIA M GROTH
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Credential |
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Telephone | 904-223-3321
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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