| NPI | 1619794328 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTHONY THADDEUS CLAVO Medical Director 404-354-0153 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine |
| 261QP3300X Clinic/Center, Pain | |
| Enumeration Date | 2024-09-24 |
| Last Update Date | 2024-09-24 |