Provider Demographics
NPI:1275633372
Name:INTERVENTIONAL SPINE AND PAIN MANAGEMENT, PC
Entity Type:Organization
Organization Name:INTERVENTIONAL SPINE AND PAIN MANAGEMENT, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-929-9033
Mailing Address - Street 1:5303 ADAMS ST.
Mailing Address - Street 2:SUITE C
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014
Mailing Address - Country:US
Mailing Address - Phone:678-729-8590
Mailing Address - Fax:678-729-8595
Practice Address - Street 1:5303 ADAMS ST.
Practice Address - Street 2:SUITE C
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014
Practice Address - Country:US
Practice Address - Phone:678-729-8590
Practice Address - Fax:678-729-8595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty