Organization
GRACE PAIN & WELLNESS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANTHONY THADDEUS CLAVO MD (MEDICAL DIRECTOR)
(404) 354-0153
Entity
Organization
Contact information
Practice address
6101 W PLANO PKWY STE 200, PLANO, TX 75093-8373
(404) 354-0153
Mailing address
4145 BELT LINE RD STE 212-237, ADDISON, TX 75001-4324
(404) 354-0153
Taxonomy
Speciality
Code
Description
License number
State
171400000X
Health & Wellness Coach
—
—
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
208VP0014X
Interventional Pain Medicine Physician
Primary
—
—
261QP3300X
Pain Clinic/Center
—
—
Other
Enumeration date
09/24/2024
Last updated
09/24/2024
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