Provider Demographics
NPI:1487098174
Name:NEXUS PAIN CENTER OF ALBANY LLC
Entity type:Organization
Organization Name:NEXUS PAIN CENTER OF ALBANY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSIAH
Authorized Official - Middle Name:S
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:229-496-1874
Mailing Address - Street 1:2810 MEREDYTH DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707
Mailing Address - Country:US
Mailing Address - Phone:229-496-1874
Mailing Address - Fax:229-329-4460
Practice Address - Street 1:2810 MEREDYTH DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707
Practice Address - Country:US
Practice Address - Phone:229-496-1874
Practice Address - Fax:229-329-4460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-24
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207L00000X, 207LP2900X, 208VP0000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty