Provider Demographics
NPI:1003321407
Name:MIGHTY OAKS PAIN AND SPINE CLINIC LLC
Entity Type:Organization
Organization Name:MIGHTY OAKS PAIN AND SPINE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRITMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-527-4489
Mailing Address - Street 1:14 PROFESSIONAL CT SW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-2832
Mailing Address - Country:US
Mailing Address - Phone:706-295-7333
Mailing Address - Fax:
Practice Address - Street 1:14 PROFESSIONAL CT SW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-2832
Practice Address - Country:US
Practice Address - Phone:706-295-7333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty