Organization
INTERVENTIONAL PAIN INSTITUTE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIE MICHAEL FUSSELL DO (PHYSICIAN)
(229) 405-2470
Entity
Organization
Contact information
Practice address
3200 GILLIONVILLE RD, ALBANY, GA 31721-2815
(229) 405-2470
(229) 405-2473
Mailing address
2800 OLD DAWSON RD STE 2, #245, ALBANY, GA 31707-1413
(229) 405-2470
(229) 405-2473
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GA57620
GA57620
GA
Enumeration date
03/30/2021
Last updated
10/26/2022
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