Provider Demographics
NPI:1407475296
Name:GEORGIA INJURY & PAIN SPECIALISTS
Entity Type:Organization
Organization Name:GEORGIA INJURY & PAIN SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:HAMMETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-777-3759
Mailing Address - Street 1:7001 HODGSON MEMORIAL DR STE 5
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-2549
Mailing Address - Country:US
Mailing Address - Phone:912-777-3759
Mailing Address - Fax:
Practice Address - Street 1:7001 HODGSON MEMORIAL DR STE 5
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2549
Practice Address - Country:US
Practice Address - Phone:912-777-3759
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-11
Last Update Date:2020-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1629053459Medicaid
GA1720038037Medicaid
GA1881104990Medicaid
UT1780114348Medicaid