Provider Demographics
NPI:1497105803
Name:GEORGIA INTERVENTIONAL PAIN - C, LLC
Entity Type:Organization
Organization Name:GEORGIA INTERVENTIONAL PAIN - C, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AMIT
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-962-3642
Mailing Address - Street 1:455 PHILIP BLVD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-8767
Mailing Address - Country:US
Mailing Address - Phone:770-962-3642
Mailing Address - Fax:770-962-3643
Practice Address - Street 1:1200 BALD RIDGE MARINA RD
Practice Address - Street 2:SUITE 160
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-8526
Practice Address - Country:US
Practice Address - Phone:770-962-3642
Practice Address - Fax:770-962-3643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-16
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I059775Medicare PIN