Provider Demographics
NPI:1770865396
Name:FALCON MEDICAL GROUP
Entity Type:Organization
Organization Name:FALCON MEDICAL GROUP
Other - Org Name:VICTORY PAIN MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORGANIZER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-951-9050
Mailing Address - Street 1:PO BOX 12308
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30914-2308
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1301 BROAD ST
Practice Address - Street 2:SUITE 102
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-1055
Practice Address - Country:US
Practice Address - Phone:706-723-5894
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-10
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty