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General NPI Number Information
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NPI Number | 1942357983
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Entity Type | Organization
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Legal Business Name | SOUTHEASTERN PAIN SPECIALISTS, P.C.
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 06/16/2010
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Provider Practice Location Address
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Address Line | 1140 HAMMOND DRIVE D 4190
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City | ATLANTA
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State | GA
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Zip | 30328-5331
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Country | US
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Telephone | 770-558-8501
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Fax | 770-558-8512
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Provider Business Mailing Address
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Address Line | 1140 HAMMOND DRIVE D 4190
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City | ATLANTA
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State | GA
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Zip | 30328-5331
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Country | US
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Telephone | 770-558-8501
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Fax | 770-558-8512
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. DONALD E KIRK
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Credential |
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Telephone | 770-558-8501
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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 |
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License Number State |
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