Organization
BACK TO LIFE MEDICAL GROUP, LLC
Active
Organization
BACK TO LIFE MEDICAL GROUP, LLC
Active
Parent organization
BACK TO LIFE MEDICAL GROUP, LLC
Other names
Georgia Pain Treatment Centers
Organization subpart
Yes
Provider details
NPI number
Legal business name
BACK TO LIFE MEDICAL GROUP, LLC
Authorized official
SATISH CUDDAPAH MD (MEDICAL DIRECTOR)
(770) 345-2000
Entity
Organization
Contact information
Practice address
557 RIVERSTONE PKWY, SUITE 140, CANTON, GA 30114-5223
(770) 345-2000
(770) 345-4524
Mailing address
557 RIVERSTONE PKWY, SUITE 140, CANTON, GA 30114-5223
(770) 345-2000
(770) 345-4524
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
—
—
Other
Enumeration date
11/01/2011
Last updated
06/22/2015
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