NPIMap

Organization Active NPI

Georgia Pain and Wellness Center, LLC

  • Interventional Pain Medicine Physician
  • Decatur, GA
National Provider Identifier
1689186199
Registry record updated Mar 31, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
Legal business name
GEORGIA PAIN AND WELLNESS CENTER, LLC
Practice address
484 Irvin CT Ste 110
Decatur, GA 30030-5406
Phone
(770) 962-3642
Fax
(770) 962-3643
NPI assigned
Oct 25, 2017
Organization subpart
Yes
Parent organization
GEORGIA PAIN AND WELLNESS CENTER, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 31, 2021

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

Authorized official

Name
Dr. Amit Patel, MD
Title
Ceo
Phone
(770) 962-3642

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Pain Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208VP0014X Primary
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

484 Irvin CT Ste 110
Decatur, GA 30030-5406

Mailing address

455 Philip Blvd Ste 140
Lawrenceville, GA 30046-8768
Phone (770) 962-3642

Other names 1

  • Summit Spine & Joint Centers Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171031000802 GA DME Supplier - Physician - Interventional Pain Management 8527200864 Practice locations: Decatur, GA

Other NPIs with the same Medicare PAC ID 13

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

View all 13

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
11D2225832Georgia Pain and Wellness Center, LLC484 Irvin Court Suite 110, Decatur, GA 30030Certificate of waiverMay 24, 2027

National Provider Directory

National Provider Directory
Tax ID family
Georgia Pain and Wellness Center LLC16 organizations share this tax ID, including this one
Part of
Georgia Pain and Wellness Center LLC

Other organizations with this tax ID 15

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

View all 15

Locations

1255 Friendship Rd
Ste 150
Braselton, GA 30517

830 Eagles Landing Pkwy
Ste 204
Stockbridge, GA 30281

203 Woodpark Pl
Ste B102
Woodstock, GA 30188
Phone (770) 926-0021

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1508889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617148800000",
    "number": "1689186199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "455 PHILIP BLVD STE 140",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300468768",
            "telephone_number": "770-962-3642",
            "fax_number": "770-962-3643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "484 IRVIN CT STE 110",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300305406",
            "telephone_number": "770-962-3642",
            "fax_number": "770-962-3643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA PAIN AND WELLNESS CENTER, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GEORGIA PAIN AND WELLNESS CENTER, LLC",
        "enumeration_date": "2017-10-25",
        "last_updated": "2021-03-31",
        "certification_date": "2021-03-31",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "AMIT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "770-962-3642",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Summit Spine & Joint Centers",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Decatur, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2021; 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.