Provider Demographics
NPI:1669700241
Name:LANIER INTERVENTIONAL PAIN CENTER, LLC
Entity type:Organization
Organization Name:LANIER INTERVENTIONAL PAIN CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:GIVOGRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-297-0356
Mailing Address - Street 1:2335 LIMESTONE OVERLOOK
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-7443
Mailing Address - Country:US
Mailing Address - Phone:770-297-0356
Mailing Address - Fax:770-297-7564
Practice Address - Street 1:2335 LIMESTONE OVERLOOK
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-7443
Practice Address - Country:US
Practice Address - Phone:770-297-0356
Practice Address - Fax:770-297-7564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-19
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical