Provider Demographics
NPI:1720443252
Name:INTERVENTIONAL SPINE AND PAIN MANGEMENT CENTER, PC
Entity type:Organization
Organization Name:INTERVENTIONAL SPINE AND PAIN MANGEMENT CENTER, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-403-8310
Mailing Address - Street 1:3390 PEACHTREE RD NE
Mailing Address - Street 2:SUITE 1500
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326-1157
Mailing Address - Country:US
Mailing Address - Phone:770-929-9033
Mailing Address - Fax:770-929-9092
Practice Address - Street 1:134 RIVERSTONE TER
Practice Address - Street 2:SUITE 101
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-1706
Practice Address - Country:US
Practice Address - Phone:770-929-9033
Practice Address - Fax:770-929-9092
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTERVENTIONAL SPINE AND PAIN MANAGEMENT CENTER, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-29
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty