Provider Demographics
NPI:1912388976
Name:ROSWELL PAIN SURGICAL CENTER
Entity Type:Organization
Organization Name:ROSWELL PAIN SURGICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAMON
Authorized Official - Middle Name:CHRISTIAN
Authorized Official - Last Name:KIMES
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:678-736-7680
Mailing Address - Street 1:1300 UPPER HEMBREE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-0927
Mailing Address - Country:US
Mailing Address - Phone:678-736-7680
Mailing Address - Fax:
Practice Address - Street 1:1300 UPPER HEMBREE RD
Practice Address - Street 2:SUITE B
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-0927
Practice Address - Country:US
Practice Address - Phone:678-736-7680
Practice Address - Fax:888-537-5362
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROSWELL PAIN SPECIALISTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical