Provider Demographics
NPI:1831486430
Name:ROSWELL PAIN SPECIALISTS
Entity Type:Organization
Organization Name:ROSWELL PAIN SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAMON
Authorized Official - Middle Name:C
Authorized Official - Last Name:KIMES
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:404-759-9658
Mailing Address - Street 1:1300 UPPER HEMBREE RD SUITE B1 BUILDING 100
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076
Mailing Address - Country:US
Mailing Address - Phone:678-736-7680
Mailing Address - Fax:888-537-5362
Practice Address - Street 1:1300 UPPER HEMBREE RD SUITE B1 BUILDING 100
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076
Practice Address - Country:US
Practice Address - Phone:678-736-7680
Practice Address - Fax:888-537-5362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-01
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050322208VP0000X, 261QP3300X
208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAH08902Medicare UPIN
GA202G703763Medicare PIN