Georgia Interventional Pain - G, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

GEORGIA INTERVENTIONAL PAIN - G, LLC

Practice address

1504 N Thornton Ave Ste 104
Dalton, GA 30720-8394

Phone

(770) 962-3642

Fax

(770) 962-3643

NPI assigned

Mar 9, 2020

Last updated

Jan 13, 2023By 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

Dr. Amit Patel, MDNPI 1386834117

Title

Medical Director

Phone

(770) 962-3642

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Listed as

Georgia Interventional Pain G LLCCCN 11C0001527

Medicare certification status

ActiveFrom the Provider of Services file

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

CLIA laboratory certificates

Locations

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.

• Amit Patel, MD

  • Anesthesiology Physician
  • Lawrenceville, GA
  • NPI 1386834117
  NPD (past) Authorized official

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

{
    "created_epoch": "1583712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673568000000",
    "number": "1114552338",
    "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": "1504 N THORNTON AVE STE 104",
            "city": "DALTON",
            "state": "GA",
            "postal_code": "307208394",
            "telephone_number": "770-962-3642",
            "fax_number": "770-962-3643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA INTERVENTIONAL PAIN - G, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-09",
        "last_updated": "2023-01-13",
        "certification_date": "2023-01-13",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "AMIT",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "770-962-3642",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Gardner Raye Gentry, MS, NCC, LPC
• Karen Odell Gentry, LPN
• Samantha L Gentry
• Georgia CVS Pharmacy LLC (CVS Pharmacy # 03767)
• Georgia Dental Professionals, PC (Dug Gap Family Dentistry)
• Georgia Pain and Wellness Center (Summit Sine & Joint Centers)
• Katie Jane Geraldson, FNP-BC
• Rebecca Geren, PT
• German Garcia MD PC
• Nancy Drown Giammarella, CNP

• Ambulatory Surgical Clinic/Center in Dalton, GA
• Providers in Dalton, GA by specialty
• Ambulatory Surgical Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2023; 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.