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General NPI Number Information
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NPI Number | 1902769912
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Entity Type | Organization
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Legal Business Name | GEORGIA INTERVENTIONAL PAIN - U, LLC
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Dates
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Enumeration Date | 12/05/2025
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 455 PHILIP BLVD STE 140
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-8768
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Country | US
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Telephone | 770-962-3642
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Fax | 770-962-3643
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Provider Business Mailing Address
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Address Line | 1111 GLYNCO PKWY STE 26
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City | BRUNSWICK
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State | GA
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Zip | 31525-7930
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | AMIT PATEL
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Credential | MD
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Telephone | 770-962-3642
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 |
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