Provider Demographics
NPI:1275841215
Name:ATLANTA SPINE AND ALTERNATIVE PAIN MANAGEMENT CENTER, LLC
Entity Type:Organization
Organization Name:ATLANTA SPINE AND ALTERNATIVE PAIN MANAGEMENT CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ARTENA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-355-2728
Mailing Address - Street 1:1938 PEACHTREE RD NW
Mailing Address - Street 2:SUITE 610
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1267
Mailing Address - Country:US
Mailing Address - Phone:404-355-2728
Mailing Address - Fax:404-355-2785
Practice Address - Street 1:1938 PEACHTREE RD NW
Practice Address - Street 2:SUITE 610
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1267
Practice Address - Country:US
Practice Address - Phone:770-333-9405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-23
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0564542081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty