Provider Demographics
NPI:1245474550
Name:ATLANTA PAIN AND SPINE PHYSICIANS, LLC
Entity type:Organization
Organization Name:ATLANTA PAIN AND SPINE PHYSICIANS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:CABLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-436-4450
Mailing Address - Street 1:3200 HIGHLANDS PKWY SE
Mailing Address - Street 2:SUITE 420
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-5166
Mailing Address - Country:US
Mailing Address - Phone:770-436-4450
Mailing Address - Fax:
Practice Address - Street 1:3200 HIGHLANDS PKWY SE
Practice Address - Street 2:SUITE 420
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-5166
Practice Address - Country:US
Practice Address - Phone:770-436-4450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-30
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047711207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202G051911Medicare PIN
GA6378400001Medicare NSC