Provider Demographics
NPI:1013394766
Name:MODERN PAIN MANAGEMENT PLLC
Entity Type:Organization
Organization Name:MODERN PAIN MANAGEMENT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:ATALLAH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:713-298-0120
Mailing Address - Street 1:902 FROSTWOOD
Mailing Address - Street 2:SUITE 235
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024
Mailing Address - Country:US
Mailing Address - Phone:713-298-0120
Mailing Address - Fax:713-513-5303
Practice Address - Street 1:902 FROSTWOOD
Practice Address - Street 2:SUITE 235
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024
Practice Address - Country:US
Practice Address - Phone:713-298-0120
Practice Address - Fax:713-513-5303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-01
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207LP2900X
TXP1162208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty