Provider Demographics
NPI:1164828976
Name:ATLANTA PAIN AND WELLNESS CENTER PC
Entity Type:Organization
Organization Name:ATLANTA PAIN AND WELLNESS CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAJIV
Authorized Official - Middle Name:
Authorized Official - Last Name:SOOD
Authorized Official - Suffix:
Authorized Official - Credentials:D O
Authorized Official - Phone:404-556-9328
Mailing Address - Street 1:1287 GA HWY 138 SPUR STE 8
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-2419
Mailing Address - Country:US
Mailing Address - Phone:770-473-0038
Mailing Address - Fax:
Practice Address - Street 1:1287 GA HWY 138 SPUR STE 8
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-2419
Practice Address - Country:US
Practice Address - Phone:770-473-0038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain