Provider Demographics
NPI:1861710584
Name:DR. PAIN LLC
Entity type:Organization
Organization Name:DR. PAIN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DIKLA
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-521-9992
Mailing Address - Street 1:5445 MERIDIAN MARKS RD NE STE 370
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-4766
Mailing Address - Country:US
Mailing Address - Phone:770-531-9992
Mailing Address - Fax:404-531-9901
Practice Address - Street 1:5445 MERIDIAN MARKS RD NE STE 370
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-4766
Practice Address - Country:US
Practice Address - Phone:770-531-9992
Practice Address - Fax:404-531-9901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-05
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA032502207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty