Provider Demographics
NPI:1225759236
Name:NOVA SPINE AND PAIN CARE P.C.
Entity Type:Organization
Organization Name:NOVA SPINE AND PAIN CARE P.C.
Other - Org Name:NOVA SPINE AND PAIN CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHITRA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMASUBBU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:267-901-3020
Mailing Address - Street 1:145 RIVERSTONE TER STE 101
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-5327
Mailing Address - Country:US
Mailing Address - Phone:770-450-4807
Mailing Address - Fax:
Practice Address - Street 1:145 RIVERSTONE TER STE 101
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-5327
Practice Address - Country:US
Practice Address - Phone:770-450-4807
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-07
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty