Provider Demographics
NPI:1225395718
Name:SOLAR FAMILY PRACTICE AND PAIN MANAGEMENT
Entity Type:Organization
Organization Name:SOLAR FAMILY PRACTICE AND PAIN MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOODY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-265-5994
Mailing Address - Street 1:122 SCRANTON CONNECTOR
Mailing Address - Street 2:SUITE 112
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-0533
Mailing Address - Country:US
Mailing Address - Phone:912-265-5994
Mailing Address - Fax:912-265-5999
Practice Address - Street 1:122 SCRANTON CONNECTOR
Practice Address - Street 2:SUITE 112
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525-0533
Practice Address - Country:US
Practice Address - Phone:912-265-5994
Practice Address - Fax:912-265-5999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-20
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty