Provider Demographics
NPI:1013341734
Name:CENTER FOR PAIN AND SPINE, LLC
Entity Type:Organization
Organization Name:CENTER FOR PAIN AND SPINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:GALAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-794-2106
Mailing Address - Street 1:1365 ROCK QUARRY RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-5029
Mailing Address - Country:US
Mailing Address - Phone:678-794-2106
Mailing Address - Fax:
Practice Address - Street 1:2401 NEWNAN CROSSING BLVD E
Practice Address - Street 2:SUITE 130
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-2402
Practice Address - Country:US
Practice Address - Phone:678-794-2106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical