MEDICARE: LANIER INTERVENTIONAL PAIN CENTER, LLC

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	208VP0014X	Interventional Pain Medicine Physician	038234	GA

General Provider Information

NPI Number	:	1528041803
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LANIER INTERVENTIONAL PAIN CENTER, LLC

Provider Business Mailing Address
First Line	:	2335 LIMESTONE OVERLOOK
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30501-7443
Country	:	US
Telephone Number	:	770-297-0356
Fax Number	:

Provider Business Practice Location Address
First Line	:	2335 LIMESTONE OVERLOOK
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30501-7443
Country	:	US
Telephone Number	:	770-297-0356
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOHN LEE GIVOGRE
Credential	:	M.D.
Telephone Number	:	770-297-0356

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	03/12/2024

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