Advanced Spine & Pain Interventions LLC - Jasper

Primary specialty

Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X

License

059463 Issued in 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

Last updated

May 18, 2026By the provider in NPPES

Organization subpart

Yes

Parent organization

ADVANCED SPINE & PAIN INTERVENTIONS LLCAs reported in NPPES

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

Authorized official

Name

Dr. Woodley Bernadette Mardy-DavisNPI 1619188505

Title

Medical Director

Phone

(470) 299-1998

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

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

  dba Advanced Spine & Pain Interventions

  • Interventional Pain Medicine Physician
  • Alpharetta, GA
  • NPI 1184021180

  O20150617001457

  Same enrollment

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

CLIA laboratory certificates

Part of

Advanced Spine Pain Interventions LLC - Jasper

Locations

Interoperability endpoints

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

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

  dba Advanced Spine & Pain Interventions

  • Interventional Pain Medicine Physician
  • Alpharetta, GA
  • NPI 1184021180
  NPPES parent name

Practitioners 3

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.

• Woodley Bernadette Mardy-Davis, M.D.

  • Interventional Pain Medicine Physician
  • Alpharetta, GA
  • NPI 1619188505
  Authorized official Same address or phone
• Ebanga Agbor, NP

  • Nurse Practitioner
  • Alpharetta, GA
  • NPI 1275068173
  NPD
• Kenneth Dale Wenslow, PA

  • Physician Assistant
  • Alpharetta, GA
  • NPI 1295805661
  NPD

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

{
    "created_epoch": "1523836800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1779062400000",
    "number": "1992292973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12389 CRABAPPLE RD",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300046328",
            "telephone_number": "470-299-1998",
            "fax_number": "470-299-1898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "49 GORDON RD",
            "address_2": "SUITE 102",
            "city": "JASPER",
            "state": "GA",
            "postal_code": "301431017",
            "telephone_number": "470-299-1998",
            "fax_number": "470-299-1898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED SPINE & PAIN INTERVENTIONS LLC - JASPER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ADVANCED SPINE & PAIN INTERVENTIONS LLC",
        "enumeration_date": "2018-04-16",
        "last_updated": "2026-05-18",
        "certification_date": "2026-05-18",
        "status": "A",
        "authorized_official_last_name": "MARDY-DAVIS",
        "authorized_official_first_name": "WOODLEY",
        "authorized_official_middle_name": "BERNADETTE",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "470-299-1998",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "207LA0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Addiction Medicine",
            "state": "GA",
            "license": "059463",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "GA",
            "license": "059463",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Interventional Pain Medicine Physician in Jasper, GA
• Providers in Jasper, GA by specialty
• Interventional Pain Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2026; 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.