Organization
LASER SPINE & PAIN CENTERS PRADO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VINAYA KRISHNA PUPPALA MD (CHIEF EXECUTIVE OFFICER)
(847) 340-7215
Entity
Organization
Contact information
Practice address
5505 ROSWELL RD STE 350B, SANDY SPRINGS, GA 30342-1985
(770) 627-7246
(404) 393-1611
Mailing address
403 PERMIAN WAY STE D, VILLA RICA, GA 30180-3226
(770) 627-7246
(404) 393-1611
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
12/04/2020
Last updated
12/04/2020
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