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General NPI Number Information
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NPI Number | 1659615540
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Entity Type | Organization
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Legal Business Name | CENTERS FOR PAIN MANAGEMENT OF GEORGIA LLC
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Dates
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Enumeration Date | 11/16/2012
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Last Update Date | 04/07/2021
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Provider Practice Location Address
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Address Line | 39 KENT RD STE 8
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City | TIFTON
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State | GA
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Zip | 31794-1697
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Country | US
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Telephone | 229-391-2910
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Fax | 229-386-4770
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Provider Business Mailing Address
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Address Line | PO BOX 7083
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City | TIFTON
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State | GA
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Zip | 31793-7083
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Country | US
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Telephone | 229-391-2910
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Fax | 229-238-0953
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Authorized Official
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Title or Position | BILLING/CREDENTIALING SUPERVISOR
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Name | MISTY D HOOKS
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Credential |
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Telephone | 229-238-0265
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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 | 59158
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License Number State | GA
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