PCA INTERVENTIONAL SPINE AT FAYETTE LLC NPI 1447791074

NPI Information

NPI: 1447791074
Provider Name: PCA INTERVENTIONAL SPINE AT FAYETTE, LLC
Classification: Clinic/Center - 261QP3300X
Entity Type: Organization

Specialization: Pain

CLIA Number: 11D2130828

Address:
1233 HIGHWAY 54 W
SUITE 205
FAYETTEVILLE, GA
ZIP 30214
Phone: (404) 351-7654
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PCA INTERVENTIONAL SPINE AT FAYETTE, LLC is a pain clinic center in Fayetteville, GA. PCA INTERVENTIONAL SPINE AT FAYETTE, LLC NPI is 1447791074. The provider is registered as an organization entity type.

The provider's business location address is:

1233 HIGHWAY 54 W
SUITE 205
FAYETTEVILLE, GA
ZIP 30214-542
Phone: (404) 351-7654

The provider's authorized official is Rodrigo Duralde .
The authorized official title is Owner and has the following contact phone number (404) 351-7654.

The CLIA number assigned to this NPI record is 11D2130828 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/15/2017 and was last updated on 6/11/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QA1903X	Clinic/Center	Ambulatory Surgical	IN PROCESS	GEORGIA	No
2	261QP3300X	Clinic/Center	Pain			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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