Provider Demographics
NPI:1033509203
Name:PAIN ASSOCIATES OF SOUTH GEORGIA LLC
Entity Type:Organization
Organization Name:PAIN ASSOCIATES OF SOUTH GEORGIA LLC
Other - Org Name:PAIN ASSOCIATES OF SOUTH GEORGIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:LUPI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:912-267-9000
Mailing Address - Street 1:306 ISABELLA ST
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-3636
Mailing Address - Country:US
Mailing Address - Phone:912-490-7246
Mailing Address - Fax:912-490-7247
Practice Address - Street 1:306 ISABELLA ST
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-3636
Practice Address - Country:US
Practice Address - Phone:912-267-9000
Practice Address - Fax:912-267-9028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-27
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA038152208VP0014X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty