Organization
M.E.M. MEDICAL SERVICES, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MYRON MOOREHEAD (MANAGING MEMBER)
(770) 218-9002
Entity
Organization
Contact information
Practice address
200 PARKBROOKE DR, SUITE 100, WOODSTOCK, GA 30189-6331
(770) 218-9002
(678) 384-5289
Mailing address
307 GRAY SHINGLE WAY, WOODSTOCK, GA 30189-3775
(770) 218-9002
(678) 384-5289
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
064985
GA
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
064985
GA
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
064985
GA
208VP0000X
Pain Medicine Physician
064985
GA
208VP0014X
Interventional Pain Medicine Physician
064985
GA
Other
Enumeration date
12/07/2010
Last updated
12/07/2010
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