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Organization
GEORGIA SPORTS AND PAIN PHYSICIANS PC
Active
Organization
GEORGIA SPORTS AND PAIN PHYSICIANS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RYAN HELMS CPC (CREDENTIALING AGENT)
(850) 547-5789
Entity
Organization
Contact information
Practice address
4900 IVEY RD NW, SUITE 810, ACWORTH, GA 30101-4001
(850) 547-5789
(850) 547-5789
Mailing address
4900 IVEY RD NW, SUITE 810, ACWORTH, GA 30101-4001
(850) 547-5789
(850) 547-5789
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
Primary
059870
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
059870
MEDICAL LICENSE
GA
Enumeration date
05/24/2010
Last updated
05/24/2010
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