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General NPI Number Information
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NPI Number | 1861541492
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Entity Type | Organization
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Legal Business Name | ANGEL PAIN RELIEF CENTER
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6000 SHAKERAG HILL SUITE 108
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-7077
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Country | US
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Telephone | 770-632-2770
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Fax | 770-632-2885
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Provider Business Mailing Address
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Address Line | PO BOX 3077
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-7077
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Country | US
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Telephone | 770-632-2770
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Fax | 770-632-2885
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | DR. JOHN A GATELL
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Credential | MD
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Telephone | 770-632-2770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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