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General NPI Number Information
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NPI Number | 1245654615
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Entity Type | Organization
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Legal Business Name | GEORGIA INTERVENTIONAL PAIN LLC
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Dates
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Enumeration Date | 02/05/2014
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Last Update Date | 01/13/2023
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Provider Practice Location Address
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Address Line | 455 PHILIP BLVD STE 138
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-8767
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Country | US
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Telephone | 770-962-3642
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Fax | 770-962-3642
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Provider Business Mailing Address
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Address Line | 455 PHILIP BLVD STE 140
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-8768
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Country | US
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Telephone | 770-962-3642
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Fax | 770-962-3642
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. AMIT SURYAKANT PATEL
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Credential | M.D.
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Telephone | 757-618-5889
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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 | 62929
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License Number State | GA
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