NPIMap

Organization Active NPI

Total Diagnostic and Interventional Pain PC

Doing business as TDI Pain

  • Interventional Pain Medicine Physician
  • Lagrange, GA
National Provider Identifier
1609143502
Registry record updated Jan 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
License
63786 Issued in GA
Legal business name
TOTAL DIAGNOSTIC AND INTERVENTIONAL PAIN PC
Doing business as
TDI Pain
Practice address
1075 Lafayette Pkwy
Ste 100
Lagrange, GA 30241-3584
Phone
(706) 443-5273
Fax
(706) 443-5275
NPI assigned
Nov 20, 2011
Last updated
Jan 11, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2019

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

Authorized official

Name
Davin Gerrard Mitchell, M.D.NPI 1861669517
Title
Physician
Phone
(706) 845-9370

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
Interventional Pain Medicine Physician 208VP0014X 63786 GA Primary

Addresses

Primary practice location

1075 Lafayette Pkwy
Ste 100
Lagrange, GA 30241-3584

Mailing address

1075 Lafayette Pkwy
Ste 100
Lagrange, GA 30241-3584
Phone (706) 443-5273

Other names 1

  • TDI Pain Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120731000067 GA Part B Supplier - Clinic/Group Practice 7517123904 Receives reassigned benefits from 4 practitioners
Practice locations: Lagrange, 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
11D2161394Total Diagnostic and Interventional Pain1075 Lafayette Parkway, Suite 100, Lagrange, GA 30241AccreditationSep 24, 2027

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

1075 Lafayette Pkwy
Ste 100
Lagrange, GA 30241
Phone (706) 443-5273

1955 Roanoke Rd
Lagrange, GA 30240
Phone (706) 443-5273

Practitioners & affiliated clinicians

Practitioners 5

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": "1321747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1547164800000",
    "number": "1609143502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1075 LAFAYETTE PKWY",
            "address_2": "STE 100",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302413584",
            "telephone_number": "706-443-5273",
            "fax_number": "706-443-5275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1075 LAFAYETTE PKWY",
            "address_2": "STE 100",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302413584",
            "telephone_number": "706-443-5273",
            "fax_number": "706-443-5275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TOTAL DIAGNOSTIC AND INTERVENTIONAL PAIN PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-20",
        "last_updated": "2019-01-11",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "DAVIN",
        "authorized_official_middle_name": "GERRARD",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "706-845-9370",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "GA",
            "license": "63786",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TDI Pain",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lagrange, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2019; 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.