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General NPI Number Information
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NPI Number | 1568327211
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Entity Type | Organization
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Legal Business Name | PAIN TREATMENT CENTERS OF GEORGIA LLC
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Dates
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Enumeration Date | 12/16/2025
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Last Update Date | 12/16/2025
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Provider Practice Location Address
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Address Line | 303 S MAIN ST
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City | SWAINSBORO
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State | GA
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Zip | 30401-3613
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Country | US
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Telephone | 912-910-3777
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Fax | 912-292-0005
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Provider Business Mailing Address
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Address Line | 604 W OGLETHORPE HWY
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City | HINESVILLE
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State | GA
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Zip | 31313-4415
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Country | US
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Telephone | 912-910-3777
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Fax | 912-292-0005
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Authorized Official
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Title or Position | OWNER/MD
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Name | VADIM PETROV-KONDRATOV
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Credential |
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Telephone | 912-910-3777
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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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Taxonomy #2
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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