Provider Demographics
NPI:1073844205
Name:ATLANTA PAIN & INJURY PC
Entity Type:Organization
Organization Name:ATLANTA PAIN & INJURY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAILESH
Authorized Official - Middle Name:SUSHIL
Authorized Official - Last Name:KOTHARI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-938-2625
Mailing Address - Street 1:1938 COBBLESTONE CIR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30319-4905
Mailing Address - Country:US
Mailing Address - Phone:770-938-2625
Mailing Address - Fax:404-477-0906
Practice Address - Street 1:800 VIRGINIA AVE
Practice Address - Street 2:STE 200
Practice Address - City:HAPEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30354-4302
Practice Address - Country:US
Practice Address - Phone:770-938-2625
Practice Address - Fax:404-477-0906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-28
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO08446111N00000X
GA024649207R00000X
GA044228207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty