Provider Demographics
NPI:1538227566
Name:ADVANCED PAIN MANAGEMENT, P.C.
Entity type:Organization
Organization Name:ADVANCED PAIN MANAGEMENT, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HEMANT
Authorized Official - Middle Name:
Authorized Official - Last Name:YAGNICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-922-7246
Mailing Address - Street 1:404 TOWN PARK BOULEVARD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809
Mailing Address - Country:US
Mailing Address - Phone:706-922-7246
Mailing Address - Fax:
Practice Address - Street 1:404 TOWN PARK BOULEVARD
Practice Address - Street 2:SUITE 101
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809
Practice Address - Country:US
Practice Address - Phone:706-922-7246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055321207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA558 441 890 BMedicaid
GA05 BD KZGMedicare ID - Type Unspecified
GA558 441 890 BMedicaid