Provider Demographics
NPI:1184395113
Name:CSPM GA PC
Entity type:Organization
Organization Name:CSPM GA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAHID
Authorized Official - Middle Name:
Authorized Official - Last Name:SOHANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-450-1222
Mailing Address - Street 1:715 QUEEN CITY PKWY STE 106
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-4335
Mailing Address - Country:US
Mailing Address - Phone:678-450-1222
Mailing Address - Fax:706-279-2679
Practice Address - Street 1:3993 LAWRENCEVILLE HWY NW STE 130
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-2831
Practice Address - Country:US
Practice Address - Phone:678-450-1222
Practice Address - Fax:706-279-2679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-21
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty