Pain Treatment Centers of Georgia LLC

Primary specialty

Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X

Legal business name

PAIN TREATMENT CENTERS OF GEORGIA LLC

Practice address

1907 Sunset Blvd
Jesup, GA 31545-7813

Phone

(912) 910-3777

NPI assigned

Apr 6, 2023

Last updated

Jun 17, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Vadim Petrov-Kondratov, MDNPI 1891061040

Title

Physician Owner

Phone

(912) 910-3777

Specialties & licenses 1

Addresses

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.

• Vadim Petrov-Kondratov, M.D.

  • Interventional Pain Medicine Physician
  • Hinesville, GA
  • NPI 1891061040
  Authorized official Same address or phone

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

{
    "created_epoch": "1680739200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718582400000",
    "number": "1447945407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "604 W OGLETHORPE HWY",
            "city": "HINESVILLE",
            "state": "GA",
            "postal_code": "313134415",
            "telephone_number": "912-910-3777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1907 SUNSET BLVD",
            "city": "JESUP",
            "state": "GA",
            "postal_code": "315457813",
            "telephone_number": "912-910-3777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAIN TREATMENT CENTERS OF GEORGIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-06",
        "last_updated": "2024-06-17",
        "certification_date": "2024-06-17",
        "status": "A",
        "authorized_official_last_name": "PETROV-KONDRATOV",
        "authorized_official_first_name": "VADIM",
        "authorized_official_title_or_position": "PHYSICIAN OWNER",
        "authorized_official_telephone_number": "912-910-3777",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ogochukwu C Okpala, MD, MPH, MBA
• Optim Orthopedics, LLC (Optim Orthopedics)
• Matthew Orzelek, PT, DPT
• Vincent Perris Omozeh Oyagha, LPC, NCC
• Jeffrey Padgett
• Paulette Parker, LCSW
• Sarah Elizabeth Paulino-Plummer
• Peachtree Family Medicine, LLC.
• Angela Perry, NP
• Pham General Surgery, P.C.

• Pain Medicine (Anesthesiology) Physician in Jesup, GA
• Providers in Jesup, GA by specialty
• Pain Medicine (Anesthesiology) Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2024; 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.