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General NPI Number Information
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NPI Number | 1417661281
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Entity Type | Organization
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Legal Business Name | SUPREME SPINE AND PAIN PHYSICIANS LLC
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Dates
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Enumeration Date | 01/06/2023
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Last Update Date | 03/30/2025
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Provider Practice Location Address
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Address Line | 335 PEACHTREE INDUSTRIAL BLVD STE 2206
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City | SUWANEE
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State | GA
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Zip | 30024-3721
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Country | US
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Telephone | 507-319-2391
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Fax |
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Provider Business Mailing Address
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Address Line | 335 PEACHTREE INDUSTRIAL BLVD STE 2206
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City | SUWANEE
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State | GA
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Zip | 30024-3721
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Country | US
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Telephone | 770-810-5188
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DANQING HU
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Credential | MD, PHD
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Telephone | 770-810-5188
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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