Provider Demographics
NPI:1386195378
Name:PAIN MANAGEMENT AND REHABILITATION INC.
Entity Type:Organization
Organization Name:PAIN MANAGEMENT AND REHABILITATION INC.
Other - Org Name:MY PAIN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KHALIQUE
Authorized Official - Middle Name:U
Authorized Official - Last Name:REHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-288-3311
Mailing Address - Street 1:4121 STEVE REYNOLDS BLVD
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-3060
Mailing Address - Country:US
Mailing Address - Phone:770-288-3311
Mailing Address - Fax:770-288-3824
Practice Address - Street 1:4121 STEVE REYNOLDS BLVD
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-3060
Practice Address - Country:US
Practice Address - Phone:770-288-3311
Practice Address - Fax:770-288-3824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-14
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA541162081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty