Provider Demographics
NPI:1821047069
Name:THE HEMLOCK PAIN CENTER, LLC
Entity Type:Organization
Organization Name:THE HEMLOCK PAIN CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:N
Authorized Official - Last Name:TAFOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-745-2385
Mailing Address - Street 1:101 PRESTON COURT
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-5771
Mailing Address - Country:US
Mailing Address - Phone:478-745-2385
Mailing Address - Fax:478-745-1225
Practice Address - Street 1:101 PRESTON COURT
Practice Address - Street 2:SUITE 103
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-5771
Practice Address - Country:US
Practice Address - Phone:478-745-2385
Practice Address - Fax:478-745-1225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-06
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207L00000X, 207LP2900X, 208VP0000X, 208VP0014X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADD0909OtherRAILROAD MEDICARE
GA482417805AMedicaid
GAGRP7068Medicare PIN