Provider Demographics
NPI:1225242399
Name:EXPERT PAIN CLINIC LLC
Entity Type:Organization
Organization Name:EXPERT PAIN CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:GHADAMYARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-452-4288
Mailing Address - Street 1:3042 OAKCIFF RD
Mailing Address - Street 2:SITE210
Mailing Address - City:DORAVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30340
Mailing Address - Country:US
Mailing Address - Phone:770-452-4288
Mailing Address - Fax:770-452-4289
Practice Address - Street 1:3042 OAKCIFF RD
Practice Address - Street 2:SITE210
Practice Address - City:DORAVILLE
Practice Address - State:GA
Practice Address - Zip Code:30340
Practice Address - Country:US
Practice Address - Phone:770-452-4288
Practice Address - Fax:770-452-4289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR006529111N00000X
GA032558207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty