NPIMap

Organization Active NPI

Pain and Spine Solutions, LLC

  • Specialist
  • Lithonia, GA
National Provider Identifier
1073850988
Registry record updated Jan 11, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
040758 Issued in GA
Legal business name
PAIN AND SPINE SOLUTIONS, LLC
Practice address
3974 Glen Park Drive
Lithonia, GA 30038
Phone
(404) 403-4567
Fax
(404) 920-8185
NPI assigned
Jan 11, 2013
Last updated
Jan 11, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2013

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

Authorized official

Name
Dr. Marcus Polk, M.D.NPI 1669454575
Title
Anesthesiologist
Phone
(404) 403-4567

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 040758 GA Primary

Addresses

Primary practice location

3974 Glen Park Drive
Lithonia, GA 30038

Mailing address

3974 Glen Park Drive
Lithonia, GA 30038
Phone (404) 403-4567

Other identifiers 1

IdentifierTypeStateIssuer
000820036SMedicaidGA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1357862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1357862400000",
    "number": "1073850988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3974 GLEN PARK DRIVE",
            "city": "LITHONIA",
            "state": "GA",
            "postal_code": "30038",
            "telephone_number": "404-403-4567",
            "fax_number": "404-920-8185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3974 GLEN PARK DRIVE",
            "city": "LITHONIA",
            "state": "GA",
            "postal_code": "30038",
            "telephone_number": "404-403-4567",
            "fax_number": "404-920-8185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAIN AND SPINE SOLUTIONS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-11",
        "last_updated": "2013-01-11",
        "status": "A",
        "authorized_official_last_name": "POLK",
        "authorized_official_first_name": "MARCUS",
        "authorized_official_title_or_position": "ANESTHESIOLOGIST",
        "authorized_official_telephone_number": "404-403-4567",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "GA",
            "license": "040758",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000820036S",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lithonia, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2013; 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.