# BACK TO LIFE PAIN CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Back To Life Pain Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1982172060
- **Authorized official:** DR. KONSTANTIN SERGEYEVICH TSYMBALOV DO (OWNER)
- **Authorized official phone:** (678) 909-0911

## Contact information

- **Practice address:** 410 CREEKSTONE RDG, WOODSTOCK, GA 30188-3740
- **Practice address phone:** (678) 909-0911
- **Practice address fax:** (678) 909-0912
- **Mailing address:** 410 CREEKSTONE RDG, WOODSTOCK, GA 30188-3740
- **Mailing address phone:** (678) 909-0911
- **Mailing address fax:** (678) 909-0912

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | NULL | Yes |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/07/2018
- **Last updated:** 08/14/2020