Back to Life Medical Group, LLC

Primary specialty

Non-Pharmacy Dispensing SiteTaxonomy code 332900000X

Legal business name

BACK TO LIFE MEDICAL GROUP, LLC

Practice address

557 Riverstone Pkwy
Suite 140
Canton, GA 30114-5223

Phone

(770) 345-2000

Fax

(770) 345-4524

NPI assigned

Nov 1, 2011

Organization subpart

Yes

Parent organization

BACK TO LIFE MEDICAL GROUP, LLCAs reported in NPPES

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

Authorized official

Name

Satish Cuddapah, MD

Title

Medical Director

Phone

(770) 345-2000

Specialties & licenses 1

Addresses

Other names 1

• Georgia Pain Treatment Centers Doing business as

Part of

Back to Life Med Group

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Back to Life Medical Group, LLC

  • Family Medicine Physician
  • Canton, GA
  • NPI 1396987152
  NPPES parent name

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

• Eric Anthony Cavaciuti, DC

  • Chiropractor
  • Canton, GA
  • NPI 1407974538
  NPD

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

{
    "created_epoch": "1320105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1434931200000",
    "number": "1346526530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "557 RIVERSTONE PKWY",
            "address_2": "SUITE 140",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301145223",
            "telephone_number": "770-345-2000",
            "fax_number": "770-345-4524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "557 RIVERSTONE PKWY",
            "address_2": "SUITE 140",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301145223",
            "telephone_number": "770-345-2000",
            "fax_number": "770-345-4524"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BACK TO LIFE MEDICAL GROUP, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BACK TO LIFE MEDICAL GROUP, LLC",
        "enumeration_date": "2011-11-01",
        "last_updated": "2015-06-22",
        "status": "A",
        "authorized_official_last_name": "CUDDAPAH",
        "authorized_official_first_name": "SATISH",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "770-345-2000",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Georgia Pain Treatment Centers",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Gordon Jerome Azar Jr., M.D., F.A.C.C.
• Nader Baaklini
• Jennifer Bacchus, PHARMD
• Back 2 Back Chiropractic Canton LLC
• Back to Life
• Back to Life Medical Group, LLC
• Adam Davis Bagley, LMFT
• Robert Bagwell Jr., PHARMD
• Priscilla Di Bailey
• Cindy Baker, MA CCC-SLP

• All providers in Canton, GA
• Non-Pharmacy Dispensing Site in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2015; 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.