Provider Demographics
NPI:1699214965
Name:PAIN CENTERS OF ATLANTA
Entity Type:Organization
Organization Name:PAIN CENTERS OF ATLANTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:JEFFERSON
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-915-1405
Mailing Address - Street 1:4535 WINTERS CHAPEL RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:DORAVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30360-2705
Mailing Address - Country:US
Mailing Address - Phone:678-580-1862
Mailing Address - Fax:678-580-1648
Practice Address - Street 1:4535 WINTERS CHAPEL RD
Practice Address - Street 2:SUITE A
Practice Address - City:DORAVILLE
Practice Address - State:GA
Practice Address - Zip Code:30360-2705
Practice Address - Country:US
Practice Address - Phone:678-580-1862
Practice Address - Fax:678-580-1648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-19
Last Update Date:2017-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA409261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain