Provider Demographics
NPI:1790263960
Name:ELITE PAIN CENTER LLC
Entity Type:Organization
Organization Name:ELITE PAIN CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:T
Authorized Official - Last Name:KARL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:912-530-7516
Mailing Address - Street 1:186 S MACON ST
Mailing Address - Street 2:
Mailing Address - City:JESUP
Mailing Address - State:GA
Mailing Address - Zip Code:31545-1117
Mailing Address - Country:US
Mailing Address - Phone:912-530-7516
Mailing Address - Fax:912-350-7517
Practice Address - Street 1:1907 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31545-7813
Practice Address - Country:US
Practice Address - Phone:912-530-7516
Practice Address - Fax:912-559-6191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-31
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA62371207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty