Provider Demographics
NPI:1326137100
Name:NORTH GEORGIA PAIN CLINIC
Entity Type:Organization
Organization Name:NORTH GEORGIA PAIN CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:H
Authorized Official - Last Name:STRAUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-479-2322
Mailing Address - Street 1:1320 OAKSIDE DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-2475
Mailing Address - Country:US
Mailing Address - Phone:770-479-2322
Mailing Address - Fax:770-720-7695
Practice Address - Street 1:1320 OAKSIDE DR
Practice Address - Street 2:SUITE 203
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-2475
Practice Address - Country:US
Practice Address - Phone:770-479-2322
Practice Address - Fax:770-720-7695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP643Medicare ID - Type Unspecified