Organization
BRUNSWICK PAIN TREATMENT CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANEKA TINCH (RCM MANAGER)
(469) 458-9222
Entity
Organization
Contact information
Practice address
1111 GLYNCO PKWY, 3RD FLOOR, BRUNSWICK, GA 31525
(912) 262-6552
(912) 262-0112
Mailing address
4960 SW 72ND AVE STE 405, MIAMI, FL 33155-5506
(469) 458-9222
(540) 918-7202
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
0411782
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00200372
MEDICARE RAILROAD
GA
Enumeration date
09/26/2006
Last updated
12/08/2025
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