Provider Demographics
NPI:1043390149
Name:PAIN SPECIALIST CORP.
Entity Type:Organization
Organization Name:PAIN SPECIALIST CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANA MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PLATON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-507-6995
Mailing Address - Street 1:1506 ROCK QUARRY RD
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-5047
Mailing Address - Country:US
Mailing Address - Phone:770-507-6995
Mailing Address - Fax:770-507-8252
Practice Address - Street 1:1506 ROCK QUARRY RD
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-5047
Practice Address - Country:US
Practice Address - Phone:770-507-6995
Practice Address - Fax:770-507-8252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADC1773OtherGRP RRMCR NUMBER
GADC1773OtherGRP RRMCR NUMBER
GAH62806Medicare UPIN