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General NPI Number Information
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NPI Number | 1992387260
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE PAIN AND SPINE CONSULTANTS OF GEORGIA
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Dates
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Enumeration Date | 04/26/2021
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Last Update Date | 04/27/2022
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Provider Practice Location Address
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Address Line | 1531 SIENNA TRACE DR
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City | GRAYSON
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State | GA
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Zip | 30017-2936
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Country | US
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Telephone | 509-795-6014
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Fax | 509-357-8236
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Provider Business Mailing Address
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Address Line | 1531 SIENNA TRACE DR
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City | GRAYSON
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State | GA
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Zip | 30017-2936
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Country | US
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Telephone | 509-795-6014
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Fax | 509-357-8236
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Authorized Official
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Title or Position | OWNER
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Name | PRISCILLA AGBENYEFIA
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Credential | MD
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Telephone | 404-704-4174
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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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