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General NPI Number Information
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NPI Number | 1730824814
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Entity Type | Organization
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Legal Business Name | GEORGIA PAIN AND WELLNESS CENTER
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Dates
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Enumeration Date | 05/03/2022
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Last Update Date | 03/04/2026
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Provider Practice Location Address
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Address Line | 830 EAGLES LANDING PKWY STE 204
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-7366
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Country | US
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Telephone | 770-962-3642
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Fax | 770-962-3643
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Provider Business Mailing Address
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Address Line | 455 PHILIP BLVD STE 140
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-8768
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Country | US
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Telephone | 770-962-3642
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Fax | 770-962-3643
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DR. AMIT SURYAKANT PATEL
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Credential | MD
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Telephone | 770-962-3642
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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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 | 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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