Individual
SACKDINANH NOK KEOMAHATHAI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
650 HENDERSON DR STE 409, CARTERSVILLE, GA 30120-3758
(470) 274-2800
(800) 501-3088
Mailing address
650 HENDERSON DR STE 409, CARTERSVILLE, GA 30120-3758
(470) 274-2800
(800) 501-3088
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
051054
GA
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
051054
GA
208VP0014X
Interventional Pain Medicine Physician
Primary
051054
GA
Other
Enumeration date
12/13/2006
Last updated
06/19/2024
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