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General NPI Number Information
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NPI Number | 1154422541
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Entity Type | Organization
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Legal Business Name | BRUNSWICK PAIN TREATMENT CENTER, LLC
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 1111 GLYNCO PKWY 3RD FLOOR
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City | BRUNSWICK
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State | GA
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Zip | 31525
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Country | US
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Telephone | 912-262-6552
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Fax | 912-262-0112
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Provider Business Mailing Address
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Address Line | 4960 SW 72ND AVE STE 405
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City | MIAMI
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State | FL
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Zip | 33155-5506
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Country | US
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Telephone | 469-458-9222
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Fax | 540-918-7202
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Authorized Official
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Title or Position | RCM MANAGER
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Name | SHANEKA TINCH
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Credential |
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Telephone | 469-458-9222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 0411782
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License Number State | GA
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