Provider Demographics
NPI:1750859336
Name:PAIN MANAGEMENT & REHABILITATION SPECIALISTS, PC
Entity Type:Organization
Organization Name:PAIN MANAGEMENT & REHABILITATION SPECIALISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:COVINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-396-7671
Mailing Address - Street 1:4409 EVANS TO LOCKS RD
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3603
Mailing Address - Country:US
Mailing Address - Phone:706-396-7671
Mailing Address - Fax:706-228-4692
Practice Address - Street 1:4409 EVANS TO LOCKS RD
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3603
Practice Address - Country:US
Practice Address - Phone:706-396-7671
Practice Address - Fax:706-228-4692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-13
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA6382350001OtherDME PTAN