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General NPI Number Information
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NPI Number | 1790263960
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Entity Type | Organization
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Legal Business Name | ELITE PAIN CENTER LLC
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Dates
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Enumeration Date | 07/31/2018
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Last Update Date | 09/19/2019
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Provider Practice Location Address
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Address Line | 1907 SUNSET BLVD
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City | JESUP
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State | GA
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Zip | 31545-7813
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Country | US
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Telephone | 912-530-7516
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Fax | 912-559-6191
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Provider Business Mailing Address
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Address Line | 186 S MACON ST
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City | JESUP
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State | GA
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Zip | 31545-1117
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Country | US
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Telephone | 912-530-7516
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Fax | 912-350-7517
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | PATRICK T KARL
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Credential | DO
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Telephone | 912-530-7516
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 62371
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License Number State | GA
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