=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669428983
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTER FOR SPINE & PAIN MEDICINE, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/26/2006
-----------------------------------------------------
Last Update Date | 08/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1413 CHATTANOOGA AVE
-----------------------------------------------------
City | DALTON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30720-2631
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-279-2635
-----------------------------------------------------
Fax | 706-279-2679
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1413 CHATTANOOGA AVE
-----------------------------------------------------
City | DALTON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30720-2631
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-279-2635
-----------------------------------------------------
Fax | 706-279-2679
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE ADMINISTRATOR
-----------------------------------------------------
Name | MR. SULEMAN SOHANI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 706-279-2635
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number | 155-336
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------