Provider Demographics
NPI:1487878856
Name:SUWANEE PAIN MANAGEMENT CENTER INC
Entity type:Organization
Organization Name:SUWANEE PAIN MANAGEMENT CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:K
Authorized Official - Last Name:STURRUP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-831-1933
Mailing Address - Street 1:415 PEACHTREE INDUSTRIAL BLVD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6710
Mailing Address - Country:US
Mailing Address - Phone:770-831-1933
Mailing Address - Fax:770-831-1934
Practice Address - Street 1:415 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:SUITE 600
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6710
Practice Address - Country:US
Practice Address - Phone:770-831-1933
Practice Address - Fax:770-831-1934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP7292Medicare ID - Type UnspecifiedLEGACY PIN