Provider Demographics
NPI:1215364047
Name:NATIONAL PAIN PHYSICIANS
Entity Type:Organization
Organization Name:NATIONAL PAIN PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:WINSOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-485-1396
Mailing Address - Street 1:1929 TRINITY MILL DR
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-1006
Mailing Address - Country:US
Mailing Address - Phone:678-485-1396
Mailing Address - Fax:
Practice Address - Street 1:715 QUEEN CITY PKWY
Practice Address - Street 2:#106
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-4348
Practice Address - Country:US
Practice Address - Phone:770-531-5115
Practice Address - Fax:770-531-5116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-13
Last Update Date:2013-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA03158363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA387169911BMedicaid