Provider Demographics
NPI:1497858971
Name:PAIN SOLUTIONS TREATMENT CENTERS
Entity Type:Organization
Organization Name:PAIN SOLUTIONS TREATMENT CENTERS
Other - Org Name:GEORGIA PAIN CLINIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:GAYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-590-1078
Mailing Address - Street 1:PO BOX 4779
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30061-4779
Mailing Address - Country:US
Mailing Address - Phone:770-590-1078
Mailing Address - Fax:
Practice Address - Street 1:400 TOWER RD NE
Practice Address - Street 2:SUITE 350
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-9415
Practice Address - Country:US
Practice Address - Phone:770-590-1078
Practice Address - Fax:770-422-7306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2011-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA00049726208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP3103Medicare PIN