MEDICARE: PAIN SPECIALIST CORP.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LP2900X	Pain Medicine (Anesthesiology) Physician		GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DC1773	OTHER	GA	GRP RRMCR NUMBER

General Provider Information

NPI Number	:	1043390149
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAIN SPECIALIST CORP.

Provider Business Mailing Address
First Line	:	1506 ROCK QUARRY RD
Second Line	:
City	:	STOCKBRIDGE
State	:	GA
Zip	:	30281-5047
Country	:	US
Telephone Number	:	770-507-6995
Fax Number	:	770-507-8252

Provider Business Practice Location Address
First Line	:	1506 ROCK QUARRY RD
Second Line	:
City	:	STOCKBRIDGE
State	:	GA
Zip	:	30281-5047
Country	:	US
Telephone Number	:	770-507-6995
Fax Number	:	770-507-8252

Authorized Official
Title or Position	:	PRESIDENT / OWNER
Name	:	ANA MARIA PLATON
Credential	:	MD
Telephone Number	:	770-507-6995

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	08/30/2010

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Directions to “PAIN SPECIALIST CORP. ” Practice Location

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