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General NPI Number Information
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NPI Number | 1861710584
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Entity Type | Organization
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Legal Business Name | DR. PAIN LLC
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Dates
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Enumeration Date | 05/05/2010
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Last Update Date | 05/05/2010
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Provider Practice Location Address
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Address Line | 5445 MERIDIAN MARKS RD NE STE 370
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City | ATLANTA
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State | GA
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Zip | 30342-4766
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Country | US
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Telephone | 770-531-9992
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Fax | 404-531-9901
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Provider Business Mailing Address
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Address Line | 5445 MERIDIAN MARKS RD NE STE 370
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City | ATLANTA
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State | GA
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Zip | 30342-4766
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Country | US
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Telephone | 770-531-9992
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Fax | 404-531-9901
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Authorized Official
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Title or Position | PRACTICE DIRECTOR
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Name | DIKLA R ROSH
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Credential |
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Telephone | 404-521-9992
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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 | 032502
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License Number State | GA
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