Organization
PCA INTERVENTIONAL SPINE AT FAYETTE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RODRIGO DURALDE MD (OWNER)
(404) 351-7654
Entity
Organization
Contact information
Practice address
1233 HIGHWAY 54 W, SUITE 205, FAYETTEVILLE, GA 30214-4542
(404) 351-7654
Mailing address
PO BOX 40061, BELFAST, ME 04915-1237
(678) 971-4167
(833) 989-2501
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
IN PROCESS
GA
261QP3300X
Pain Clinic/Center
Primary
—
—
Other
Enumeration date
03/15/2017
Last updated
02/20/2026
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