Provider Demographics
NPI:1790908721
Name:SOLLAGE PAIN SOLUTIONS OF FL
Entity Type:Organization
Organization Name:SOLLAGE PAIN SOLUTIONS OF FL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:L
Authorized Official - Last Name:BUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-910-7545
Mailing Address - Street 1:1922 MOUNT ZION RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30054-2624
Mailing Address - Country:US
Mailing Address - Phone:678-910-7545
Mailing Address - Fax:770-573-7432
Practice Address - Street 1:1922 MOUNT ZION RD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:GA
Practice Address - Zip Code:30054-2624
Practice Address - Country:US
Practice Address - Phone:678-910-7545
Practice Address - Fax:770-573-7432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9353AMedicare ID - Type Unspecified