NPIMap

Organization Active NPI

Georgia Pain and Spine Solutions, PC

  • Pain Medicine (Anesthesiology) Physician
  • Hiram, GA
National Provider Identifier
1255820502
Registry record updated Apr 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
License
040758 Issued in GA
Legal business name
GEORGIA PAIN AND SPINE SOLUTIONS, PC
Practice address
76 Highland Pavilion Court
#133
Hiram, GA 30141-3170
Phone
(800) 533-8210
Fax
(404) 745-8013
NPI assigned
May 2, 2018
Reactivated
Jul 26, 2019
Last updated
Apr 28, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2020

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

Authorized official

Name
Marcus Q Polk, MDNPI 1669454575
Title
President/Ceo
Phone
(404) 403-4567

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) Physician 207LP2900X 040758 GA Primary

Addresses

Primary practice location

76 Highland Pavilion Court
#133
Hiram, GA 30141-3170

Mailing address

P.O. Box 370160
Decatur, GA 30037-0160
Phone (404) 403-4567

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mbb@medicalmanagement.com Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180920003070 GA Part B Supplier - Clinic/Group Practice 9931450566 Receives reassigned benefits from 1 practitioner
Practice locations: Hiram, GA

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
11D2154585Georgia Pain and Spine Solutions, PC76 Highland Pavillion Court, Suite 133, Hiram, GA 30141Certificate of waiverSep 16, 2026

National Provider Directory

National Provider Directory

Locations

76 Highland Pavilion Ct
Ste 133
Hiram, GA 30141
Phone (770) 439-1172

76 Highland Pavilion Ct
Ste 133A
Hiram, GA 30141
Phone (404) 403-4567

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/18187/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 53

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.

View all 53

NPI Registry JSON

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

{
    "created_epoch": "1525219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588032000000",
    "number": "1255820502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 370160",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300370160",
            "telephone_number": "404-403-4567",
            "fax_number": "404-920-8185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "76 HIGHLAND PAVILION COURT",
            "address_2": "#133",
            "city": "HIRAM",
            "state": "GA",
            "postal_code": "301413170",
            "telephone_number": "800-533-8210",
            "fax_number": "404-745-8013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA PAIN AND SPINE SOLUTIONS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-02",
        "last_updated": "2020-04-28",
        "certification_date": "2020-04-28",
        "deactivation_date": "2019-07-19",
        "reactivation_date": "2019-07-26",
        "status": "A",
        "authorized_official_last_name": "POLK",
        "authorized_official_first_name": "MARCUS",
        "authorized_official_middle_name": "Q",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "404-403-4567",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "GA",
            "license": "040758",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mbb@medicalmanagement.com",
            "affiliation": "N",
            "endpointDescription": "E-mail",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2784 N Decatur Rd Ste 120",
            "city": "Decatur",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300335993",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Hiram, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2020; 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.