Provider Demographics
NPI:1356635965
Name:SANDY SPRINGS PAIN CENTER
Entity Type:Organization
Organization Name:SANDY SPRINGS PAIN CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:EDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-661-8602
Mailing Address - Street 1:7260 ROSWELL RD NE
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328-1420
Mailing Address - Country:US
Mailing Address - Phone:678-336-9065
Mailing Address - Fax:678-336-9470
Practice Address - Street 1:7260 ROSWELL RD NE
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-1420
Practice Address - Country:US
Practice Address - Phone:678-336-9065
Practice Address - Fax:678-336-9470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-01
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA023877208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty