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General NPI Number Information
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NPI Number | 1124286521
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Entity Type | Organization
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Legal Business Name | PHYSICIANS INSTITUTE FOR PAIN MANAGEMENT, LLC
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Dates
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Enumeration Date | 06/02/2008
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Last Update Date | 09/17/2008
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Provider Practice Location Address
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Address Line | 2418 N OAK ST SUITE B 1
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City | VALDOSTA
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State | GA
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Zip | 31602-2576
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Country | US
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Telephone | 229-247-3300
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Fax | 229-247-1131
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Provider Business Mailing Address
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Address Line | 2418 N OAK ST SUITE B 1
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City | VALDOSTA
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State | GA
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Zip | 31602-2576
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Country | US
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Telephone | 229-247-3300
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Fax | 229-247-1131
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Authorized Official
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Title or Position | MD
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Name | JAMES HARRISON CAMPAGNA
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Credential |
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Telephone | 229-247-3300
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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 | 033806
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License Number State | GA
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