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General NPI Number Information
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NPI Number | 1457707184
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Entity Type | Organization
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Legal Business Name | THE INTERVENTIONAL SPINE AND PAIN MANAGEMENT CENTER PC
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Dates
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Enumeration Date | 05/12/2016
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 300 PARKBROOKE PL STE 390
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City | WOODSTOCK
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State | GA
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Zip | 30189-7209
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Country | US
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Telephone | 770-929-9033
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Fax | 770-929-9092
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Provider Business Mailing Address
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Address Line | 3390 PEACHTREE RD NE SUITE 1500
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City | ATLANTA
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State | GA
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Zip | 30326-1157
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Country | US
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Telephone | 404-920-4950
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | ERIN SHERROD
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Credential |
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Telephone | 404-920-4950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State | GA
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