Provider Demographics
NPI:1780017194
Name:GEORGIA PAIN PHYSICIANS PC
Entity Type:Organization
Organization Name:GEORGIA PAIN PHYSICIANS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:WINDSOR
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:770-850-8464
Mailing Address - Street 1:2550 WINDY HILL RD SE
Mailing Address - Street 2:STE 215
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8665
Mailing Address - Country:US
Mailing Address - Phone:770-850-8464
Mailing Address - Fax:770-850-9727
Practice Address - Street 1:541 FOREST PKWY
Practice Address - Street 2:STE 14
Practice Address - City:FOREST PARK
Practice Address - State:GA
Practice Address - Zip Code:30297-6144
Practice Address - Country:US
Practice Address - Phone:404-366-5652
Practice Address - Fax:404-366-0322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-21
Last Update Date:2014-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1279700004Medicare NSC