Provider Demographics
NPI:1376050971
Name:COMPREHENSIVE SPINE & PAIN LLC
Entity Type:Organization
Organization Name:COMPREHENSIVE SPINE & PAIN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VINAYA
Authorized Official - Middle Name:K
Authorized Official - Last Name:PUPPALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-627-7246
Mailing Address - Street 1:PO BOX 20476
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4099
Mailing Address - Country:US
Mailing Address - Phone:770-627-7246
Mailing Address - Fax:855-332-9452
Practice Address - Street 1:403 PERMIAN WAY STE D
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-3226
Practice Address - Country:US
Practice Address - Phone:770-627-7246
Practice Address - Fax:855-332-9452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-04
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty