Provider Demographics
NPI:1447539697
Name:ATL PAIN MANAGEMENT CONSULTING GROUP LLC
Entity type:Organization
Organization Name:ATL PAIN MANAGEMENT CONSULTING GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:DIDURO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-580-1862
Mailing Address - Street 1:4535 WINTERS CHAPEL RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30360-2705
Mailing Address - Country:US
Mailing Address - Phone:678-580-1862
Mailing Address - Fax:
Practice Address - Street 1:4535 WINTERS CHAPEL RD
Practice Address - Street 2:SUITE B
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30360-2705
Practice Address - Country:US
Practice Address - Phone:678-580-1862
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-05
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty