Organization
JEFFERSON PAIN CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. AHMAD GHADAMYARI (PRESIDENT)
(706) 387-0027
Entity
Organization
Contact information
Practice address
1351 WASHINGTON ST, JEFFERSON, GA 30549-2879
(706) 387-0027
(706) 387-0073
Mailing address
PO BOX 680904, MARIETTA, GA 30068-0016
(706) 387-0027
(706) 387-0073
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
Primary
032558
GA
Other
Enumeration date
02/27/2008
Last updated
02/27/2008
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