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General NPI Number Information
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NPI Number | 1790854206
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Entity Type | Organization
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Legal Business Name | INTERVENTIONAL PAIN INSTITUTE, INCORPORATED
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 378 W CHESTNUT ST SUITE 105
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City | WASHINGTON
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State | PA
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Zip | 15301-4659
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Country | US
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Telephone | 724-222-5471
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Fax | 724-222-0305
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Provider Business Mailing Address
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Address Line | 804 SCOTT NIXON MEMORIAL DR
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City | AUGUSTA
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State | GA
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Zip | 30907-2464
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Country | US
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Telephone | 800-394-4445
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Fax | 706-955-0735
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Authorized Official
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Title or Position | OWNER
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Name | WILLIE MICHAEL FUSSELL
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Credential | DO
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Telephone | 724-228-1414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State | PA
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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 | PA
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