Organization
AUGUSTA INTERVENTIONAL PAIN AND REHABILITATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VENKATA LAKKIMSETTY MD (PHYSICIAN)
(419) 508-4608
Entity
Organization
Contact information
Practice address
1355 INDEPENDENCE DR, AUGUSTA, GA 30901-1037
(419) 508-4608
Mailing address
720 BON AIR DR, AUGUSTA, GA 30907-4872
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
67138
GA
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
67138
GA
Other
Enumeration date
03/07/2012
Last updated
03/07/2012
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