Provider Demographics
NPI:1528119252
Name:SAMSON PAIN CENTER
Entity type:Organization
Organization Name:SAMSON PAIN CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAT
Authorized Official - Middle Name:P
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
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:770-544-0302
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:770-544-0302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA16359261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical