Provider Demographics
NPI:1376999094
Name:INTERVENTIONAL SPINE & PAIN MANAGEMENT CENTER, PC
Entity Type:Organization
Organization Name:INTERVENTIONAL SPINE & PAIN MANAGEMENT CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-920-4950
Mailing Address - Street 1:3390 PEACHTREE RD NE
Mailing Address - Street 2:SUITE 1500
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326-1157
Mailing Address - Country:US
Mailing Address - Phone:404-920-4950
Mailing Address - Fax:
Practice Address - Street 1:15 MEDICAL DR NE
Practice Address - Street 2:SUITE 301
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30121-8005
Practice Address - Country:US
Practice Address - Phone:770-929-9033
Practice Address - Fax:770-929-9092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-12
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty