Provider Demographics
NPI:1871681957
Name:NEXUS PAIN CENTER OF HOUSTON COUNTY
Entity Type:Organization
Organization Name:NEXUS PAIN CENTER OF HOUSTON COUNTY
Other - Org Name:AXIS PAIN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHANDRESH
Authorized Official - Middle Name:
Authorized Official - Last Name:VIRADIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-971-4001
Mailing Address - Street 1:100 JIM MASON CT STE A
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-8965
Mailing Address - Country:US
Mailing Address - Phone:478-971-4001
Mailing Address - Fax:478-971-4004
Practice Address - Street 1:100 JIM MASON CT
Practice Address - Street 2:STE A
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-8965
Practice Address - Country:US
Practice Address - Phone:478-474-2947
Practice Address - Fax:478-971-4004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA63082174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP7682Medicare PIN