Provider Demographics
NPI:1023466851
Name:AAA PAIN MANAGEMENT
Entity type:Organization
Organization Name:AAA PAIN MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:WIMSATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-732-4154
Mailing Address - Street 1:188 THOMAS JOHNSON DR
Mailing Address - Street 2:102
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4505
Mailing Address - Country:US
Mailing Address - Phone:301-732-4154
Mailing Address - Fax:
Practice Address - Street 1:188 THOMAS JOHNSON DR
Practice Address - Street 2:102
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4505
Practice Address - Country:US
Practice Address - Phone:301-732-4154
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-02
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty