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General NPI Number Information
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NPI Number | 1942637954
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Entity Type | Organization
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Legal Business Name | PAIN MANAGEMENT SPECIALISTS OF ATLANTA P C
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Dates
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Enumeration Date | 10/04/2013
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Last Update Date | 12/11/2013
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Provider Practice Location Address
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Address Line | 165 N PARK TRL SUITE 100
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-6500
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Country | US
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Telephone | 770-506-1800
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Fax | 770-506-4686
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Provider Business Mailing Address
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Address Line | 440 PRIME PT
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-3309
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Country | US
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Telephone | 770-486-7470
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Fax | 770-486-7478
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Authorized Official
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Title or Position | OWNER
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Name | RANDALL BERINHOUT
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Credential | MD
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Telephone | 770-506-1800
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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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