Provider Demographics
NPI:1700351400
Name:PAIN CENTER AT PIEDMONT, LLC
Entity Type:Organization
Organization Name:PAIN CENTER AT PIEDMONT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:XAVIER
Authorized Official - Middle Name:ORLANDO
Authorized Official - Last Name:BRENT
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:678-782-7999
Mailing Address - Street 1:1050 EAGLES LANDING PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-9250
Mailing Address - Country:US
Mailing Address - Phone:678-216-8934
Mailing Address - Fax:
Practice Address - Street 1:1050 EAGLES LANDING PKWY STE 300
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-9250
Practice Address - Country:US
Practice Address - Phone:678-216-8934
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-09
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Single Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty