Advanced Spine & Pain Interventions, LLC

Primary specialty

Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X

License

059463 Issued in GA

Legal business name

ADVANCED SPINE & PAIN INTERVENTIONS, LLC

Practice address

12389 Crabapple Rd
Alpharetta, GA 30004-6328

Phone

(470) 299-1998

Fax

(470) 299-1898

NPI assigned

Nov 19, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Woodley Bernadette Mardy-DavisNPI 1619188505

Title

Medical Director

Phone

(470) 299-1998

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Advanced Spine & Pain Interventions Doing business as

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Advanced Spine & Pain Interventions LLC - Jasper

  • Interventional Pain Medicine Physician
  • Jasper, GA
  • NPI 1992292973

  O20150617001457

  Same enrollment

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

CLIA laboratory certificates

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Advanced Spine & Pain Interventions LLC - Jasper

  • Interventional Pain Medicine Physician
  • Jasper, GA
  • NPI 1992292973
  NPPES parent name

Practitioners 3

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

• Woodley Bernadette Mardy-Davis, M.D.

  • Interventional Pain Medicine Physician
  • Alpharetta, GA
  • NPI 1619188505

  GA

  Medicare reassignment Authorized official
• Ebanga Agbor, NP

  • Nurse Practitioner
  • Alpharetta, GA
  • NPI 1275068173

  GA

  Medicare reassignment NPD
• Kenneth Dale Wenslow, PA

  • Physician Assistant
  • Alpharetta, GA
  • NPI 1295805661

  GA

  Medicare reassignment

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

{
    "created_epoch": "1416355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1779062400000",
    "number": "1184021180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12389 CRABAPPLE RD",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300046328",
            "telephone_number": "470-299-1998",
            "fax_number": "470-299-1898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12389 CRABAPPLE RD",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300046328",
            "telephone_number": "470-299-1998",
            "fax_number": "470-299-1898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED SPINE & PAIN INTERVENTIONS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-19",
        "last_updated": "2026-05-18",
        "certification_date": "2026-05-18",
        "status": "A",
        "authorized_official_last_name": "MARDY-DAVIS",
        "authorized_official_first_name": "WOODLEY",
        "authorized_official_middle_name": "BERNADETTE",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "470-299-1998",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "207LA0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Addiction Medicine",
            "state": "GA",
            "license": "059463",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "GA",
            "license": "059463",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2152738",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Spine & Pain Interventions",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Alpharetta, GA
• Interventional Pain Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2026; 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.