Provider Demographics
NPI:1306583141
Name:OPTIMUM PAIN MANAGEMENT CENTER LLC
Entity type:Organization
Organization Name:OPTIMUM PAIN MANAGEMENT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-451-1828
Mailing Address - Street 1:4775 JIMMY CARTER BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-3752
Mailing Address - Country:US
Mailing Address - Phone:678-451-1828
Mailing Address - Fax:678-451-1829
Practice Address - Street 1:4775 JIMMY CARTER BLVD STE 102
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-3752
Practice Address - Country:US
Practice Address - Phone:678-451-1828
Practice Address - Fax:678-451-1829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-13
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty