360 Medical Management

Primary specialty

SpecialistTaxonomy code 174400000X

License

058478 Issued in GA

Legal business name

360 MEDICAL MANAGEMENT

Doing business as

The Pain Management Clinic of Woodstock

Practice address

200 Parkbrooke Dr
Suite 200
Woodstock, GA 30189-6331

Phone

(770) 591-8360

Fax

(770) 591-8364

NPI assigned

Nov 10, 2008

Last updated

May 1, 2009By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Myron Moorehead

Title

Managing Member

Phone

(770) 591-8360

Specialties & licenses 1

Addresses

Other names 1

• The Pain Management Clinic of Woodstock Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1226275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1241136000000",
    "number": "1013161637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 PARKBROOKE DR",
            "address_2": "SUITE 100",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301896331",
            "telephone_number": "770-591-8360",
            "fax_number": "770-591-8364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 PARKBROOKE DR",
            "address_2": "SUITE 200",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301896331",
            "telephone_number": "770-591-8360",
            "fax_number": "770-591-8364"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "360 MEDICAL MANAGEMENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-10",
        "last_updated": "2009-05-01",
        "status": "A",
        "authorized_official_last_name": "MOOREHEAD",
        "authorized_official_first_name": "MYRON",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "770-591-8360"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "GA",
            "license": "058478",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Pain Management Clinic of Woodstock",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Specialist in Woodstock, GA
• Providers in Woodstock, GA by specialty
• Specialist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.