Provider Demographics
NPI:1780862409
Name:ADVANCE PAIN CENTER LLC
Entity Type:Organization
Organization Name:ADVANCE PAIN CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:THIEN
Authorized Official - Middle Name:
Authorized Official - Last Name:QUACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-831-2786
Mailing Address - Street 1:PO BOX 88456
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30356-8456
Mailing Address - Country:US
Mailing Address - Phone:404-831-2786
Mailing Address - Fax:
Practice Address - Street 1:2270 OAK RD
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-2355
Practice Address - Country:US
Practice Address - Phone:404-831-2786
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA054822207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty