NPIMap

Organization Active NPI

Georgia Spine & Pain Centers

  • Interventional Pain Medicine Physician
  • Waycross, GA
National Provider Identifier
1134769714
Registry record updated Sep 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
Legal business name
GEORGIA SPINE & PAIN CENTERS
Practice address
1507 Alice St
Waycross, GA 31501-4530
Phone
(912) 590-0973
Fax
(912) 590-0180
NPI assigned
Jan 10, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2025

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

Authorized official

Name
Alicia M Groth
Title
Credentialing Specialist
Phone
(904) 223-3321

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Pain Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208VP0014X Primary

Addresses

Primary practice location

1507 Alice St
Waycross, GA 31501-4530

Mailing address

5191 First Coast Tech Pkwy
3Rd Floor
Jacksonville, FL 32224-0609
Phone (904) 223-3321

Other names 1

  • Georgia Spine & Pain Centers, LLC Former legal business name

National Provider Directory

National Provider Directory

Locations

1218 Alice St
Ste B
Waycross, GA 31501
Phone (912) 590-0973

Practitioners & affiliated clinicians

Practitioners 74

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 74

NPI Registry JSON

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

{
    "created_epoch": "1578614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756771200000",
    "number": "1134769714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5191 FIRST COAST TECH PKWY",
            "address_2": "3RD FLOOR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322240609",
            "telephone_number": "904-223-3321",
            "fax_number": "904-223-2169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1507 ALICE ST",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315014530",
            "telephone_number": "912-590-0973",
            "fax_number": "912-590-0180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA SPINE & PAIN CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-10",
        "last_updated": "2025-09-02",
        "certification_date": "2025-04-24",
        "status": "A",
        "authorized_official_last_name": "GROTH",
        "authorized_official_first_name": "ALICIA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "904-223-3321"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Georgia Spine & Pain Centers, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Waycross, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2025; 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.