Provider Demographics
NPI:1548641681
Name:ADVANCE PAIN MANAGEMENT LLC.
Entity type:Organization
Organization Name:ADVANCE PAIN MANAGEMENT LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:RAVINDER
Authorized Official - Middle Name:
Authorized Official - Last Name:MANCHIREDDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-781-2800
Mailing Address - Street 1:150 MEDICAL BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-5053
Mailing Address - Country:US
Mailing Address - Phone:404-932-6172
Mailing Address - Fax:678-244-9160
Practice Address - Street 1:6131 S NORCROSS TUCKER RD
Practice Address - Street 2:SUITE 700
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-5536
Practice Address - Country:US
Practice Address - Phone:404-781-2800
Practice Address - Fax:678-244-9160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-15
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050585208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty