MEDICARE: CENTER FOR SPINE & PAIN MEDICINE PC

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1699283473
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR SPINE & PAIN MEDICINE PC

Provider Business Mailing Address
First Line	:	1413 CHATTANOOGA AVE
Second Line	:
City	:	DALTON
State	:	GA
Zip	:	30720-2631
Country	:	US
Telephone Number	:	706-279-2635
Fax Number	:

Provider Business Practice Location Address
First Line	:	715 QUEEN CITY PKWY STE 106
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30501-4335
Country	:	US
Telephone Number	:	678-450-1222
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	SADIQ SOHANI
Credential	:
Telephone Number	:	706-279-2635

Provider Enumeration Date	:	01/16/2018
Last Update Date	:	01/16/2018

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