Pain Treatment Centers of Georgia LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

PAIN TREATMENT CENTERS OF GEORGIA LLC

Practice address

6606 Abercorn St
Savannah, GA 31405-5817

Phone

(912) 910-3777

Fax

(912) 292-0005

NPI assigned

Sep 6, 2024

Organization subpart

No

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

Authorized official

Name

Vadim Petrov-Kondratov, MDNPI 1891061040

Title

Owner

Phone

(912) 910-3777

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Pain Treatment Centers of Georgia LLC

  • Pain Clinic/Center
  • Richmond Hill, GA
  • NPI 1134909542

  7012302425

  Same PAC ID
• Pain Treatment Centers of Georgia LLC

  • Clinic/Center
  • Hinesville, GA
  • NPI 1548931249

  7012302425

  Same PAC ID

Tax ID family

Pain Treatment Centers of Georgia LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Pain Treatment Centers of Georgia LLC

  • Pain Medicine (Anesthesiology) Physician
  • Vidalia, GA
  • NPI 1447185129
  NPD tax ID
• Pain Treatment Centers of Georgia LLC

  • Pain Medicine Physician
  • Swainsboro, GA
  • NPI 1568327211
  NPD tax ID

Locations

Practitioners 1

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

• Vadim Petrov-Kondratov, M.D.

  • Interventional Pain Medicine Physician
  • Hinesville, GA
  • NPI 1891061040
  NPD (past) Authorized official

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

{
    "created_epoch": "1725580800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725580800000",
    "number": "1619702792",
    "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",
            "fax_number": "912-292-0005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6606 ABERCORN ST",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314055817",
            "telephone_number": "912-910-3777",
            "fax_number": "912-292-0005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAIN TREATMENT CENTERS OF GEORGIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-06",
        "last_updated": "2024-09-06",
        "certification_date": "2024-09-06",
        "status": "A",
        "authorized_official_last_name": "PETROV-KONDRATOV",
        "authorized_official_first_name": "VADIM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "912-910-3777",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP3300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Pain",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aaliyah Page
• Amanda Page, APRN, FNP-C, ENP-C
• Caroline Page, DMD
• Sanjeeva Sumitra Pagidi
• Helen Paglia, DO
• William Zachary Painter, PHARMD
• John Domenic Paletta, M.D.
• Nina Jo Paletta, MD
• Palliation Choice, Inc
• Palliation Choices

• All providers in Savannah, GA
• Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.