Provider Demographics
NPI:1538196191
Name:PAIN MANAGEMENT SPECIALISTS OF ATLANTA PC
Entity type:Organization
Organization Name:PAIN MANAGEMENT SPECIALISTS OF ATLANTA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:BERINHOUT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-506-1800
Mailing Address - Street 1:165 NORTH PARK TRAIL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281
Mailing Address - Country:US
Mailing Address - Phone:770-506-1800
Mailing Address - Fax:770-506-4686
Practice Address - Street 1:165 NORTH PARK TRAIL
Practice Address - Street 2:SUITE 100
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281
Practice Address - Country:US
Practice Address - Phone:770-506-1800
Practice Address - Fax:770-506-4686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA351179600OtherDEPT OF LABOR
GAGRP7051Medicare PIN