Provider Demographics
NPI:1669428983
Name:CENTER FOR SPINE & PAIN MEDICINE, PC
Entity type:Organization
Organization Name:CENTER FOR SPINE & PAIN MEDICINE, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SULEMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOHANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-279-2635
Mailing Address - Street 1:1413 CHATTANOOGA AVE
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-2631
Mailing Address - Country:US
Mailing Address - Phone:706-279-2635
Mailing Address - Fax:706-279-2679
Practice Address - Street 1:1413 CHATTANOOGA AVE
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-2631
Practice Address - Country:US
Practice Address - Phone:706-279-2635
Practice Address - Fax:706-279-2679
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTER FOR SPINE & PAIN MEDICINE, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-26
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA155-336261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA435371871AMedicaid
GAP00346261OtherRAILROAD MCARE INDIVIDUAL