Provider Demographics
NPI:1780264911
Name:PAIN MANAGEMENT SPECIALISTS OF ATLANTA, PC
Entity type:Organization
Organization Name:PAIN MANAGEMENT SPECIALISTS OF ATLANTA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST PRACTICE ADMNISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MONK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-506-1800
Mailing Address - Street 1:165 N PARK TRL
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-6500
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:616A S 8TH ST
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-4214
Practice Address - Country:US
Practice Address - Phone:770-233-8570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PAIN MANAGEMENT SPECIALIST OF ATLANTA PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty