Provider Demographics
NPI:1811432321
Name:COMPREHENSIVE SPINE & PAIN, LLC
Entity type:Organization
Organization Name:COMPREHENSIVE SPINE & PAIN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:
Authorized Official - First Name:V.K.
Authorized Official - Middle Name:
Authorized Official - Last Name:PUPPALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-627-7246
Mailing Address - Street 1:403 PERMIAN WAY
Mailing Address - Street 2:SUITE D
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-1247
Mailing Address - Country:US
Mailing Address - Phone:770-627-7246
Mailing Address - Fax:855-332-9452
Practice Address - Street 1:403 PERMIAN WAY STE D
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-3252
Practice Address - Country:US
Practice Address - Phone:770-627-7246
Practice Address - Fax:855-332-9452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA71014208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty