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General NPI Number Information
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NPI Number | 1447461454
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Entity Type | Organization
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Legal Business Name | SOUTHEASTERN PAIN CONSULTANTS
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 11/06/2024
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Provider Practice Location Address
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Address Line | 1976 MAIN ST E SUITE C
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City | SNELLVILLE
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State | GA
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Zip | 30078-6460
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Country | US
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Telephone | 770-982-2099
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Fax | 770-982-9045
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Provider Business Mailing Address
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Address Line | 285 HELENS MANOR DR
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-3469
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Country | US
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Telephone | 678-377-9326
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. WILLIAM PAUL IVES
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Credential | M.D.
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Telephone | 678-377-9326
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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