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General NPI Number Information
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NPI Number | 1558970640
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Entity Type | Organization
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Legal Business Name | FX SPINE AND PERFORMANCE CENTER, LLC
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Dates
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Enumeration Date | 07/24/2020
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Last Update Date | 12/03/2020
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Provider Practice Location Address
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Address Line | 106 SRP DR STE B
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City | EVANS
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State | GA
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Zip | 30809-4358
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Country | US
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Telephone | 706-842-6800
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Fax | 706-842-6780
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Provider Business Mailing Address
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Address Line | 824 KESTREL DR
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City | EVANS
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State | GA
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Zip | 30809-0328
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Country | US
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Telephone | 717-557-5926
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NICHOLAS ALLAN DEANGELO
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Credential | DO
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Telephone | 717-557-5926
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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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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