Provider Demographics
NPI:1720358401
Name:PAIN & WELLNESS CENTER OF NORTH FULTON
Entity Type:Organization
Organization Name:PAIN & WELLNESS CENTER OF NORTH FULTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SYED
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-754-1000
Mailing Address - Street 1:4180 OLD MILTON PKWY
Mailing Address - Street 2:1C
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-2408
Mailing Address - Country:US
Mailing Address - Phone:770-754-1000
Mailing Address - Fax:770-754-1010
Practice Address - Street 1:4180 OLD MILTON PKWY
Practice Address - Street 2:1C
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-2408
Practice Address - Country:US
Practice Address - Phone:770-754-1000
Practice Address - Fax:770-754-1010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA67046204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Multi-Specialty