Advanced Spine & Pain Interventions LLC - Jasper

Key facts

NPI: 1992292973
Entity type: Organization (NPI type 2)
Primary specialty: Interventional Pain Medicine Physician 208VP0014X
License: 059463 (GA)
Legal business name: ADVANCED SPINE & PAIN INTERVENTIONS LLC - JASPER
Practice address: 49 Gordon Rd
Suite 102
Jasper, GA 30143-1017
Phone: (470) 299-1998
Fax: (470) 299-1898
NPI assigned: Apr 16, 2018
Organization subpart: Yes
Parent organization (as reported): ADVANCED SPINE & PAIN INTERVENTIONS LLC

Authorized official

Name: Dr. Woodley Bernadette Mardy-Davis
Title: Medical Director
Phone: (470) 299-1998

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Advanced Spine & Pain Interventions, LLC Interventional Pain Medicine Physician · Alpharetta, GA · NPI 1184021180

NPPES parent name

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Advanced Spine & Pain Interventions, LLC Interventional Pain Medicine Physician · Alpharetta, GA · NPI 1184021180

Same enrollment O20150617001457

Practitioners 2

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

Ebanga Agbor, NP Nurse Practitioner · Alpharetta, GA · NPI 1275068173

NPD
Kenneth Dale Wenslow, PA Physician Assistant · Alpharetta, GA · NPI 1295805661

NPD

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA number	Laboratory	Certificate	Expires
11D2311457	Advanced Spine and Pain-Jasper 49 Gordon Road, Suite 102, Jasper, GA 30143	Certificate of waiver	Sep 22, 2026

Medicare participation

Medicare fee-for-service enrollment: Enrolled in GA

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20150617001457	GA	Part B Supplier - Clinic/Group Practice	3971814963	Receives reassigned benefits from 3 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Jasper, GA; Alpharetta, GA

National Provider Directory

Part of: Advanced Spine Pain Interventions LLC - Jasper

Locations

49 Gordon Rd
Ste 102
Jasper, GA 30143
Phone (470) 299-1998

Interoperability endpoints

FHIR API: https://api.platform.athenahealth.com/20208/brand/1/csg/1/fhir/r4

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Addiction Medicine (Anesthesiology) Physician Group: 193200000X MULTI-SPECIALTY GROUP	207LA0401X	059463	GA
Interventional Pain Medicine Physician Group: 193200000X MULTI-SPECIALTY GROUP	208VP0014X	059463	GA	Yes

Addresses

Primary practice location

49 Gordon Rd
Suite 102
Jasper, GA 30143-1017

Mailing address

12389 Crabapple Rd
Alpharetta, GA 30004-6328
Phone (470) 299-1998

Other providers in Jasper, GA

All providers in Jasper, GA · Interventional Pain Medicine Physician in Georgia

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 18, 2026. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Medicare Care Compare provider data (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.