Provider Demographics
NPI:1023277415
Name:ATLANTA PAIN CLINIC
Entity type:Organization
Organization Name:ATLANTA PAIN CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ASUTOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:VYAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-960-6030
Mailing Address - Street 1:3000 CORPORATE CENTER DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260-4130
Mailing Address - Country:US
Mailing Address - Phone:770-960-6030
Mailing Address - Fax:770-968-3162
Practice Address - Street 1:3000 CORPORATE CENTER DR
Practice Address - Street 2:SUITE 130
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-4130
Practice Address - Country:US
Practice Address - Phone:770-960-6030
Practice Address - Fax:770-968-3162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA041993208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG57970Medicare UPIN