NPIMap

Organization Active NPI

Pain Management & Wellness Centers of Georgia, LLC

  • Pain Clinic/Center
  • Tucker, GA
National Provider Identifier
1386903672
Registry record updated Jun 24, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Clinic/CenterTaxonomy code 261QP3300X
License
00228865 Issued in GA
Legal business name
PAIN MANAGEMENT & WELLNESS CENTERS OF GEORGIA, LLC
Practice address
4905 Lavista Rd
Suite B
Tucker, GA 30084-4409
Phone
(770) 680-5740
Fax
(770) 680-5754
NPI assigned
May 8, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2015

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

Authorized official

Name
Mr. Abraham Cohen
Title
Manager
Phone
(770) 680-5740

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X 00228865 GA
Pain Clinic/Center 261QP3300X 00228865 GA Primary

Addresses

Primary practice location

4905 Lavista Rd
Suite B
Tucker, GA 30084-4409

Mailing address

4905 Lavista Rd
Suite B
Tucker, GA 30084-4409
Phone (770) 680-5740

National Provider Directory

National Provider Directory

Locations

4905 Lavista Rd
Ste B
Tucker, GA 30084
Phone (770) 680-5740

NPI Registry JSON

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

{
    "created_epoch": "1336435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435104000000",
    "number": "1386903672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4905 LAVISTA RD",
            "address_2": "SUITE B",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300844409",
            "telephone_number": "770-680-5740",
            "fax_number": "770-680-5754"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4905 LAVISTA RD",
            "address_2": "SUITE B",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300844409",
            "telephone_number": "770-680-5740",
            "fax_number": "770-680-5754"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAIN MANAGEMENT & WELLNESS CENTERS OF GEORGIA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-08",
        "last_updated": "2015-06-24",
        "status": "A",
        "authorized_official_last_name": "COHEN",
        "authorized_official_first_name": "ABRAHAM",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "770-680-5740",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "GA",
            "license": "00228865",
            "primary": false
        },
        {
            "code": "261QP3300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Pain",
            "state": "GA",
            "license": "00228865",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucker, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 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.