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General NPI Number Information
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NPI Number | 1720358401
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Entity Type | Organization
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Legal Business Name | PAIN & WELLNESS CENTER OF NORTH FULTON
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Dates
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Enumeration Date | 01/11/2012
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Last Update Date | 01/11/2012
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Provider Practice Location Address
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Address Line | 4180 OLD MILTON PKWY 1C
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City | ALPHARETTA
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State | GA
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Zip | 30005-2408
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Country | US
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Telephone | 770-754-1000
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Fax | 770-754-1010
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Provider Business Mailing Address
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Address Line | 4180 OLD MILTON PKWY 1C
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City | ALPHARETTA
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State | GA
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Zip | 30005-2408
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Country | US
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Telephone | 770-754-1000
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Fax | 770-754-1010
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. REGINA M SYED
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Credential | DC
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Telephone | 770-754-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204C00000X
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Taxonomy Name | Sports Medicine (Neuromusculoskeletal Medicine) Physician
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License Number | 67046
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License Number State | GA
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