MEDICARE: SUN PAIN INSTITUTE 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

General Provider Information

NPI Number	:	1902433147
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUN PAIN INSTITUTE LLC

Provider Business Mailing Address
First Line	:	5354 REYNOLDS ST STE 315
Second Line	:
City	:	SAVANNAH
State	:	GA
Zip	:	31405-6010
Country	:	US
Telephone Number	:	912-692-0755
Fax Number	:	912-692-0754

Provider Business Practice Location Address
First Line	:	5354 REYNOLDS ST STE 315
Second Line	:
City	:	SAVANNAH
State	:	GA
Zip	:	31405-6010
Country	:	US
Telephone Number	:	912-692-0755
Fax Number	:	912-692-0754

Authorized Official
Title or Position	:	MD, MEMBER
Name	:	JOHN GEORGE
Credential	:	MD
Telephone Number	:	912-692-0755

Provider Enumeration Date	:	03/26/2020
Last Update Date	:	02/08/2021

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Directions to “SUN PAIN INSTITUTE LLC ” Practice Location

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