Provider Demographics
NPI:1194020016
Name:SOUTH GEORGIA PAIN MANAGEMENT
Entity Type:Organization
Organization Name:SOUTH GEORGIA PAIN MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BYRNES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:229-386-8800
Mailing Address - Street 1:416 TIFT AVE N
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-4466
Mailing Address - Country:US
Mailing Address - Phone:229-386-8800
Mailing Address - Fax:229-382-0739
Practice Address - Street 1:416 TIFT AVE N
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-4466
Practice Address - Country:US
Practice Address - Phone:229-386-8800
Practice Address - Fax:229-382-0739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008427111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty