Provider Demographics
NPI:1972891448
Name:PREMIER CHRONIC PAIN CARE INC.
Entity type:Organization
Organization Name:PREMIER CHRONIC PAIN CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RASEAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:HODGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-523-0111
Mailing Address - Street 1:619 BOULEVARD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2701
Mailing Address - Country:US
Mailing Address - Phone:404-523-0111
Mailing Address - Fax:888-291-6290
Practice Address - Street 1:619 BOULEVARD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2701
Practice Address - Country:US
Practice Address - Phone:404-523-0111
Practice Address - Fax:888-291-6290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-18
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty