Provider Demographics
NPI:1942357983
Name:SOUTHEASTERN PAIN SPECIALISTS, P.C.
Entity Type:Organization
Organization Name:SOUTHEASTERN PAIN SPECIALISTS, P.C.
Other - Org Name:SOUTHEASTERN PAIN SPECILISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:KIRK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-558-8501
Mailing Address - Street 1:1140 HAMMOND DRIVE
Mailing Address - Street 2:D 4190
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5331
Mailing Address - Country:US
Mailing Address - Phone:770-558-8501
Mailing Address - Fax:770-558-8512
Practice Address - Street 1:1140 HAMMOND DRIVE
Practice Address - Street 2:D 4190
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5331
Practice Address - Country:US
Practice Address - Phone:770-558-8501
Practice Address - Fax:770-558-8512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty