Provider Demographics
NPI:1922885755
Name:GREATER ATLANTA PAIN AND SPINE
Entity Type:Organization
Organization Name:GREATER ATLANTA PAIN AND SPINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GALAL
Authorized Official - Middle Name:Y
Authorized Official - Last Name:GARGODHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-730-9202
Mailing Address - Street 1:3840 PEACHTREE INDUSTRIAL BLVD STE 225
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-5031
Mailing Address - Country:US
Mailing Address - Phone:678-730-9202
Mailing Address - Fax:885-592-2998
Practice Address - Street 1:3840 PEACHTREE INDUSTRIAL BLVD STE 225
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-5031
Practice Address - Country:US
Practice Address - Phone:678-730-9202
Practice Address - Fax:855-592-2998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-14
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1245594985OtherNPI