Provider Demographics
NPI:1659189363
Name:CENTER FOR WELLNESS AND PAIN CARE OF LAS VEGAS INC
Entity type:Organization
Organization Name:CENTER FOR WELLNESS AND PAIN CARE OF LAS VEGAS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NEVILLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD/MBA
Authorized Official - Phone:702-476-9700
Mailing Address - Street 1:3495 BUCKHEAD LOOP NE # 19018
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326-1528
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:780 CANTON RD NE STE 330
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7289
Practice Address - Country:US
Practice Address - Phone:888-387-0080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTER FOR WELLNESS AND PAIN CARE OF LAS VEGAS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-12-27
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain