Provider Demographics
NPI:1447461454
Name:SOUTHEASTERN PAIN CONSULTANTS
Entity type:Organization
Organization Name:SOUTHEASTERN PAIN CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:IVES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-377-9326
Mailing Address - Street 1:285 HELENS MANOR DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-3469
Mailing Address - Country:US
Mailing Address - Phone:678-377-9326
Mailing Address - Fax:
Practice Address - Street 1:1976 MAIN ST E
Practice Address - Street 2:SUITE C
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-6460
Practice Address - Country:US
Practice Address - Phone:770-982-2099
Practice Address - Fax:770-982-9045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP6496Medicare ID - Type Unspecified