Provider Demographics
NPI:1366788234
Name:NEXUS PAIN CENTER OF MILLEDGEVILLE, LLC
Entity type:Organization
Organization Name:NEXUS PAIN CENTER OF MILLEDGEVILLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:CUMBIE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:478-330-5753
Mailing Address - Street 1:PO BOX 116340
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-6340
Mailing Address - Country:US
Mailing Address - Phone:706-860-2701
Mailing Address - Fax:706-860-6484
Practice Address - Street 1:111 FIELDSTONE DR
Practice Address - Street 2:SUITE 104
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-7106
Practice Address - Country:US
Practice Address - Phone:478-330-5754
Practice Address - Fax:478-330-5755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-21
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA208VP0000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty