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General NPI Number Information
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NPI Number | 1548704687
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Entity Type | Organization
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Legal Business Name | ADVANCE PAIN MANAGEMENT
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Dates
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Enumeration Date | 12/08/2016
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Last Update Date | 12/08/2016
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Provider Practice Location Address
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Address Line | 2950 STONE HOGAN ROAD CONNECTOR
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City | ATLANTA
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State | GA
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Zip | 30331
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Country | US
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Telephone | 678-886-6247
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Fax |
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Provider Business Mailing Address
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Address Line | 2950 STONE HOGAN ROAD CONNECTOR
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City | ATLANTA
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State | GA
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Zip | 30331
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Country | US
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Telephone | 678-886-6247
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF BEHAVORIAL HEALTH
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Name | DR. BEVERLY JONES
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Credential | PHD
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Telephone | 678-886-6247
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 050585
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License Number State | GA
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