Pain Treatment Centers Of Georgia LLC
Clinic/Center in Savannah, GA. Organization (NPI-2).
NPI number1619702792
StatusActive
Last updated in NPPESSep 6, 2024
Details
- NPI
- 1619702792
- Entity type
- Organization (NPI-2)
- Legal business name
- Pain Treatment Centers Of Georgia LLC
- Organization subpart
- No
- Enumeration date
- Sep 6, 2024
- Certification date
- Sep 6, 2024
- Last updated
- Sep 6, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261Q00000X | Clinic/Center | – | – | Yes |
| 261QP3300X | Clinic/Center, Pain | – | – |
Practice location
6606 Abercorn StSavannah, GA 31405-5817
Phone 912-910-3777 · Fax 912-292-0005
Mailing address
604 W Oglethorpe HwyHinesville, GA 31313-4415
Phone 912-910-3777 · Fax 912-292-0005
Authorized official
Vadim Petrov-Kondratov
Owner
9129103777
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