NPIMap

Organization Active NPI

Georgia Pain and Wellness Center, LLC

Doing business as Summit Spine & Joint Centers

  • Interventional Pain Medicine Physician
  • Carrollton, GA
National Provider Identifier
1104401819
Registry record updated May 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
Legal business name
GEORGIA PAIN AND WELLNESS CENTER, LLC
Doing business as
Summit Spine & Joint Centers
Practice address
526 Bankhead Hwy Ste 101
Carrollton, GA 30117-2463
Phone
(770) 962-3642
Fax
(770) 962-3643
NPI assigned
Mar 15, 2021
Last updated
May 20, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
GEORGIA PAIN AND WELLNESS CENTER, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 20, 2024

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

Authorized official

Name
Amit Patel, MD
Title
Ceo
Phone
(770) 962-3642

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) Physician 207LP2900X
Interventional Pain Medicine Physician 208VP0014X Primary

Addresses

Primary practice location

526 Bankhead Hwy Ste 101
Carrollton, GA 30117-2463

Mailing address

455 Philip Blvd Ste 140
Lawrenceville, GA 30046-8768
Phone (770) 962-3642

Other names 1

  • Summit Spine & Joint Centers Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210406001585 GA DME Supplier - Physician - Interventional Pain Management 8527200864 Practice locations: Carrollton, GA

Other NPIs with the same Medicare PAC ID 13

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 13

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2225532Georgia Pain and Wellness Center, LLC526 Bankhead Highway Suite 101, Carrollton, GA 30117Certificate of waiverMay 20, 2027

National Provider Directory

National Provider Directory
Tax ID family
Georgia Pain and Wellness Center LLC16 organizations share this tax ID, including this one
Part of
Georgia Pain and Wellness Center LLC

Other organizations with this tax ID 15

Organizations that report the same tax identification number in the National Provider Directory.

View all 15

Locations

146 Smitherman Rd
Ringgold, GA 30736
Phone (423) 667-3225

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1615766400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716163200000",
    "number": "1104401819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "455 PHILIP BLVD STE 140",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300468768",
            "telephone_number": "770-962-3642",
            "fax_number": "770-962-3643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "526 BANKHEAD HWY STE 101",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301172463",
            "telephone_number": "770-962-3642",
            "fax_number": "770-962-3643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA PAIN AND WELLNESS CENTER, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GEORGIA PAIN AND WELLNESS CENTER, LLC",
        "enumeration_date": "2021-03-15",
        "last_updated": "2024-05-20",
        "certification_date": "2024-05-20",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "AMIT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "770-962-3642",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Summit Spine & Joint Centers",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Summit Spine & Joint Centers",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Carrollton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.