Provider Demographics
NPI:1992162697
Name:GEORGIA PAIN MANAGEMENT GROUP LLC
Entity type:Organization
Organization Name:GEORGIA PAIN MANAGEMENT GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:SPAGNARDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-672-6918
Mailing Address - Street 1:1475 TERRELL MILL RD SE
Mailing Address - Street 2:STE 108
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-6049
Mailing Address - Country:US
Mailing Address - Phone:770-672-6918
Mailing Address - Fax:
Practice Address - Street 1:1475 TERRELL MILL RD SE
Practice Address - Street 2:STE 108
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-6049
Practice Address - Country:US
Practice Address - Phone:770-672-6918
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare