Provider Demographics
NPI:1265560379
Name:GEORGIA PAIN INSTITUTE. LLC
Entity type:Organization
Organization Name:GEORGIA PAIN INSTITUTE. LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:J
Authorized Official - Last Name:GIRON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-476-9886
Mailing Address - Street 1:PO BOX 13474
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31208-3474
Mailing Address - Country:US
Mailing Address - Phone:478-476-9886
Mailing Address - Fax:478-476-9976
Practice Address - Street 1:3356 VINEVILLE AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-2328
Practice Address - Country:US
Practice Address - Phone:478-476-9886
Practice Address - Fax:478-476-9976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG11972Medicare UPIN
GAD39754Medicare UPIN
GAG27081Medicare UPIN
GAGRP3432Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER