Organization
ADVANCED SPINE & PAIN INTERVENTIONS LLC - JASPER
Active
Parent organization
ADVANCED SPINE & PAIN INTERVENTIONS LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
ADVANCED SPINE & PAIN INTERVENTIONS LLC
Authorized official
WOODLEY MARDY-DAVIS MD (MEDICAL DIRECTOER)
(470) 299-1998
Entity
Organization
Contact information
Practice address
49 GORDON RD, SUITE 102, JASPER, GA 30143-1017
(470) 299-1998
(470) 299-1898
Mailing address
12389 CRABAPPLE RD, ALPHARETTA, GA 30004-6328
(470) 299-1998
(470) 299-1898
Taxonomy
Speciality
Code
Description
License number
State
207LA0401X
Addiction Medicine (Anesthesiology) Physician
059463
GA
208VP0014X
Interventional Pain Medicine Physician
Primary
059463
GA
Other
Enumeration date
04/16/2018
Last updated
04/19/2024
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