Provider Demographics
NPI:1851857312
Name:FAMILY FIRST HEALTHCARE PAIN MANAGEMENT, LLC
Entity Type:Organization
Organization Name:FAMILY FIRST HEALTHCARE PAIN MANAGEMENT, LLC
Other - Org Name:SUBODH K AGRAWAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTAL
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:DOBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-296-8632
Mailing Address - Street 1:2005 PRINCE AVE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-6032
Mailing Address - Country:US
Mailing Address - Phone:706-296-8632
Mailing Address - Fax:706-208-0878
Practice Address - Street 1:1999 PRINCE AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-6013
Practice Address - Country:US
Practice Address - Phone:844-641-0036
Practice Address - Fax:706-208-0878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-20
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty