MEDICARE: NEW SOUTH MEDICAL GA, 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	208VP0014X	Interventional Pain Medicine Physician

General Provider Information

NPI Number	:	1720934912
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW SOUTH MEDICAL GA, PC

Provider Business Mailing Address
First Line	:	2550 WINDY HILL RD SE STE 108A
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30067-8607
Country	:	US
Telephone Number	:	770-993-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2550 WINDY HILL RD SE STE 108A
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30067-8607
Country	:	US
Telephone Number	:	770-993-1000
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. GEOFFREY DIEK
Credential	:	DPT
Telephone Number	:	404-992-6229

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	03/09/2026

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