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General NPI Number Information
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NPI Number | 1972891448
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Entity Type | Organization
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Legal Business Name | PREMIER CHRONIC PAIN CARE INC.
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Dates
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Enumeration Date | 07/18/2011
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Last Update Date | 01/28/2014
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Provider Practice Location Address
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Address Line | 619 BOULEVARD NE
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City | ATLANTA
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State | GA
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Zip | 30308-2701
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Country | US
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Telephone | 404-523-0111
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Fax | 888-291-6290
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Provider Business Mailing Address
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Address Line | 619 BOULEVARD NE
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City | ATLANTA
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State | GA
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Zip | 30308-2701
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Country | US
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Telephone | 404-523-0111
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Fax | 888-291-6290
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Authorized Official
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Title or Position | CEO
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Name | DR. RASEAN T HODGE
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Credential |
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Telephone | 404-523-0111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | GA
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