Provider Demographics
NPI:1033392832
Name:GEORGIA PAIN MANAGEMENT
Entity type:Organization
Organization Name:GEORGIA PAIN MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:ELLNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-544-1000
Mailing Address - Street 1:120 STONEBRIDGE PKWY
Mailing Address - Street 2:SUITE 420
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-3767
Mailing Address - Country:US
Mailing Address - Phone:770-544-1000
Mailing Address - Fax:
Practice Address - Street 1:120 STONEBRIDGE PKWY
Practice Address - Street 2:SUITE 420
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-3767
Practice Address - Country:US
Practice Address - Phone:770-544-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA261QP3300X261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP4549Medicare Oscar/Certification