Provider Demographics
NPI:1093750176
Name:COLUMBUS PAIN CENTER, P.C.
Entity Type:Organization
Organization Name:COLUMBUS PAIN CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:SERRATO
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:706-322-7246
Mailing Address - Street 1:PO BOX 9456
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31908-9456
Mailing Address - Country:US
Mailing Address - Phone:706-322-7246
Mailing Address - Fax:706-596-2115
Practice Address - Street 1:7141 MOON RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-3137
Practice Address - Country:US
Practice Address - Phone:706-322-7246
Practice Address - Fax:706-596-2115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA30885208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00460171DMedicaid
GA650207OtherBCBS PROVIDER ID
GAGRP3215Medicare ID - Type UnspecifiedPROVIDER ID
GA00460171DMedicaid