Provider Demographics
NPI:1982313532
Name:VERISPINE JOINT CENTERS PC
Entity Type:Organization
Organization Name:VERISPINE JOINT CENTERS PC
Other - Org Name:VERISPINE PAIN CENTERS
Other - Org Type:Other Name
Authorized Official - Title/Position:BILLING/CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:TYE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLELLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-786-7181
Mailing Address - Street 1:1506 ROCK QUARRY RD
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-5047
Mailing Address - Country:US
Mailing Address - Phone:678-782-7999
Mailing Address - Fax:404-334-7274
Practice Address - Street 1:1506 ROCK QUARRY RD
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-5047
Practice Address - Country:US
Practice Address - Phone:678-782-7999
Practice Address - Fax:404-334-7274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-22
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPainGroup - Single Specialty