Provider Demographics
NPI:1215054671
Name:PHYSICIAN PAIN AND WELLNESS, P.C.
Entity type:Organization
Organization Name:PHYSICIAN PAIN AND WELLNESS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:DANYO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-752-9499
Mailing Address - Street 1:410 PEACHTREE PKWY
Mailing Address - Street 2:SUITE 4200
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-7066
Mailing Address - Country:US
Mailing Address - Phone:770-752-9499
Mailing Address - Fax:770-752-9166
Practice Address - Street 1:410 PEACHTREE PKWY
Practice Address - Street 2:SUITE 4200
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7066
Practice Address - Country:US
Practice Address - Phone:770-752-9499
Practice Address - Fax:770-752-9166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA041276174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA004144OtherPTAN
GAG87512Medicare UPIN
GA004144OtherPTAN