Organization Active NPI

M & M Interventional Spine

  • Interventional Pain Medicine Physician
  • Jasper, GA
National Provider Identifier
1205134673
Registry record updated Mar 8, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
License
058527 Issued in GA
Legal business name
M & M INTERVENTIONAL SPINE
Practice address
91 Sammy McGhee Blvd Ste 101
Jasper, GA 30143-7704
Phone
(706) 253-3367
Fax
(706) 253-3361
NPI assigned
Mar 8, 2011
Last updated
Mar 8, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2011

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

Authorized official

Name
Sallu JabatiNPI 1235104431
Title
Medical Director
Phone
(678) 559-4526

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Interventional Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0014X 058527 GA Primary

Addresses

Primary practice location

91 Sammy McGhee Blvd Ste 101
Jasper, GA 30143-7704

Mailing address

91 Sammy McGhee Blvd Ste 101
Jasper, GA 30143-7704
Phone (706) 253-3367

National Provider Directory

National Provider Directory

Locations

91 Sammy McGhee Blvd
Ste 101
Jasper, GA 30143
Phone (706) 253-3341

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": "1299542400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1299542400000",
    "number": "1205134673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "91 SAMMY MCGHEE BLVD STE 101",
            "city": "JASPER",
            "state": "GA",
            "postal_code": "301437704",
            "telephone_number": "706-253-3367",
            "fax_number": "706-253-3361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "91 SAMMY MCGHEE BLVD STE 101",
            "city": "JASPER",
            "state": "GA",
            "postal_code": "301437704",
            "telephone_number": "706-253-3367",
            "fax_number": "706-253-3361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "M & M INTERVENTIONAL SPINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-08",
        "last_updated": "2011-03-08",
        "status": "A",
        "authorized_official_last_name": "JABATI",
        "authorized_official_first_name": "SALLU",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "678-559-4526"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "GA",
            "license": "058527",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jasper, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2011; 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.