| NPI | 1982657524 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GAY RICHARDSON Cmo 770-850-8464 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine Pain Medicine |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine |
| 2081P2900X Physical Medicine & Rehabilitation Pain Medicine | |
| 208VP0014X Pain Medicine Interventional Pain Medicine | |
| 291U00000X Clinical Medical Laboratory | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| 363A00000X Physician Assistant | |
| 363AM0700X Physician Assistant Medical | |
| 363AS0400X Physician Assistant Surgical | |
| 363L00000X Nurse Practitioner | |
| 363LA2200X Nurse Practitioner Adult Health | |
| 363LX0106X Nurse Practitioner Occupational Health | |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2016-07-11 |