Trinity Pain Relief Center LLC
Surgery in Jonesboro, GA. Organization (NPI-2).
NPI number1114101946
StatusActive
Last updated in NPPESFeb 21, 2020
Details
- NPI
- 1114101946
- Entity type
- Organization (NPI-2)
- Legal business name
- Trinity Pain Relief Center LLC
- Organization subpart
- No
- Enumeration date
- Dec 28, 2007
- Certification date
- Feb 21, 2020
- Last updated
- Feb 21, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208600000X | Surgery | – | – | Yes |
| 111N00000X | Chiropractor | CHIR006745 | GA | |
| 111N00000X | Chiropractor | CHIR007730 | GA | |
| 207Q00000X | Family Medicine | 19354 | GA | |
| 208100000X | Physical Medicine & Rehabilitation | PT006876 | GA | |
| 225100000X | Physical Therapist | – | – |
Practice location
9434 S Main StSuite 1100
Jonesboro, GA 30236-8711
Phone 770-478-1300 · Fax 770-478-9385
Mailing address
9434 South Main StreetSuite 1100
Jonesboro, GA 30236-6092
Phone 770-478-1300 · Fax 770-478-9385
Authorized official
Genia C Fraser-Sword
Owner
7704781300
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