Provider Demographics
NPI:1942250865
Name:PAIN CONSULTANTS OF ATLANTA LLC
Entity Type:Organization
Organization Name:PAIN CONSULTANTS OF ATLANTA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF OPERATIONS/CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:ALMA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-354-1525
Mailing Address - Street 1:1233 HIGHWAY 54 W STE 207
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-4542
Mailing Address - Country:US
Mailing Address - Phone:404-351-7654
Mailing Address - Fax:404-609-7605
Practice Address - Street 1:1800 PEACHTREE ST NW STE 750
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-2530
Practice Address - Country:US
Practice Address - Phone:404-351-7654
Practice Address - Fax:678-904-5439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP3345Medicare PIN