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General NPI Number Information
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NPI Number | 1750494423
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Entity Type | Organization
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Legal Business Name | GEORGIA PAIN SPINE CENTER
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Dates
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Enumeration Date | 08/16/2006
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Last Update Date | 02/20/2020
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Provider Practice Location Address
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Address Line | 15 MEDICAL DRIVE SUITE 302
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City | CARTERSVILLE
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State | GA
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Zip | 30121
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Country | US
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Telephone | 678-337-3163
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Fax | 770-422-7306
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Provider Business Mailing Address
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Address Line | PO BOX 11407 DEPT 2657
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City | BIRMINGHAM
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State | AL
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Zip | 35246-0001
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Country | US
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Telephone | 770-920-4950
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Fax | 770-929-9092
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Authorized Official
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Title or Position | CFO
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Name | VICTORIA BECK
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Credential |
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Telephone | 404-403-8310
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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 | 008-311
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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