Organization
SOUTHERN CRESCENT PAIN MANAGEMENT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OLUFEMI AYOTUNDE OGUNYEMI MD (MEDICAL DIRECTOR)
(678) 284-1232
Entity
Organization
Contact information
Practice address
147 N PARK TRL, STOCKBRIDGE, GA 30281-7373
(678) 284-1232
(678) 284-1296
Mailing address
147 N PARK TRL, STOCKBRIDGE, GA 30281-7373
(678) 284-1232
(678) 284-1296
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
045566
GA
Other
Enumeration date
01/08/2008
Last updated
01/08/2008
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