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General NPI Number Information
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NPI Number | 1679107338
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Entity Type | Organization
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Legal Business Name | ATLANTA INTERVENTIONAL PAIN MANAGEMENT, LLC
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Dates
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Enumeration Date | 03/02/2020
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Last Update Date | 05/26/2020
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Provider Practice Location Address
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Address Line | 13190 HIGHWAY 92 STE 120
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City | WOODSTOCK
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State | GA
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Zip | 30188-4406
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Country | US
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Telephone | 770-675-9134
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Fax | 770-926-9284
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Provider Business Mailing Address
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Address Line | 13190 HIGHWAY 92 STE 120
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City | WOODSTOCK
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State | GA
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Zip | 30188-4406
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Country | US
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Telephone | 770-675-9134
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Fax | 770-926-9284
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Authorized Official
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Title or Position | MANAGER
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Name | DIANA BODDEN
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Credential |
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Telephone | 404-789-0985
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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 |
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License Number State |
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