Provider Demographics
NPI:1992024442
Name:GEORGIA SPORTS AND PAIN PHYSICIANS PC
Entity Type:Organization
Organization Name:GEORGIA SPORTS AND PAIN PHYSICIANS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING AGENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HELMS
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:850-547-5789
Mailing Address - Street 1:4900 IVEY RD NW
Mailing Address - Street 2:SUITE 810
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-4001
Mailing Address - Country:US
Mailing Address - Phone:850-547-5789
Mailing Address - Fax:850-547-5789
Practice Address - Street 1:4900 IVEY RD NW
Practice Address - Street 2:SUITE 810
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-4001
Practice Address - Country:US
Practice Address - Phone:850-547-5789
Practice Address - Fax:850-547-5789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-24
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA059870208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA059870OtherMEDICAL LICENSE