Provider Demographics
NPI:1982186425
Name:CENTER FOR SPINE & PAIN MEDICINE PC
Entity Type:Organization
Organization Name:CENTER FOR SPINE & PAIN MEDICINE PC
Other - Org Name:CSPM GSV ASC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHAHID
Authorized Official - Middle Name:
Authorized Official - Last Name:SOHANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-450-1222
Mailing Address - Street 1:1413 CHATTANOOGA AVE
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-2631
Mailing Address - Country:US
Mailing Address - Phone:706-279-2635
Mailing Address - Fax:706-279-2679
Practice Address - Street 1:715 QUEEN CITY PKWY STE 106
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-4335
Practice Address - Country:US
Practice Address - Phone:678-450-1222
Practice Address - Fax:706-279-2679
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTER FOR SPINE & PAIN MEDICINE PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-31
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical