Provider Demographics
NPI:1487014361
Name:GRIFFIN CENTER FOR PAIN AND SPINE
Entity Type:Organization
Organization Name:GRIFFIN CENTER FOR PAIN AND SPINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:LINDSEY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MATHES
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, RN, CASC
Authorized Official - Phone:770-771-6580
Mailing Address - Street 1:1365 ROCK QUARRY RD STE 202
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-5023
Mailing Address - Country:US
Mailing Address - Phone:770-771-6580
Mailing Address - Fax:770-771-6589
Practice Address - Street 1:619 S 8TH ST STE 302
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-4260
Practice Address - Country:US
Practice Address - Phone:770-771-6580
Practice Address - Fax:770-771-6589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-04
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========OtherIRS