Provider Demographics
NPI:1871204511
Name:LAWRENCEVILLE CENTER FOR PAIN AND SPINE, LLC
Entity type:Organization
Organization Name:LAWRENCEVILLE CENTER FOR PAIN AND SPINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:GALAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-771-6580
Mailing Address - Street 1:1365 ROCK QUARRY RD STE 202
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-5023
Mailing Address - Country:US
Mailing Address - Phone:770-771-6580
Mailing Address - Fax:770-771-6589
Practice Address - Street 1:755 OLD NORCROSS RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4317
Practice Address - Country:US
Practice Address - Phone:770-771-6580
Practice Address - Fax:770-771-6589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-13
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical