| Pain Treatment Centers Of Georgia Llc | |
|
604 W Oglethorpe Hwy Hinesville GA 31313-4415 | |
| (912) 910-3777 | |
| (912) 292-0005 |
| Full Name | Pain Treatment Centers Of Georgia Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 604 W Oglethorpe Hwy, Hinesville, Georgia |
| Authorized Official Name and Position | Vadim Petrov-kondratov (PHYSICIAN OWNER) |
| Authorized Official Contact | 9129103777 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pain Treatment Centers Of Georgia Llc 604 W Oglethorpe Hwy Hinesville GA 31313-4415 Ph: (912) 910-3777 | Pain Treatment Centers Of Georgia Llc 604 W Oglethorpe Hwy Hinesville GA 31313-4415 Ph: (912) 910-3777 |
| NPI Number | 1548931249 |
|---|---|
| Provider Enumeration Date | 09/22/2021 |
| Last Update Date | 09/06/2024 |
| Medicare PECOS PAC ID | 7012302425 |
|---|---|
| Medicare Enrollment ID | O20220322002325 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548931249 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| 261QP3300X | Clinic/center - Pain | (* (Not Available)) | Secondary |
| Provider Name | Wendy Brady Register |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427567304 PECOS PAC ID: 5294075966 Enrollment ID: I20190314002793 |
| Provider Name | Vadim Petrov-kondratov |
|---|---|
| Provider Type | Practitioner - Interventional Pain Management |
| Provider Identifiers | NPI Number: 1891061040 PECOS PAC ID: 6709155831 Enrollment ID: I20220322002479 |
| Provider Name | Deeran Patel |
|---|---|
| Provider Type | Practitioner - Pain Management |
| Provider Identifiers | NPI Number: 1447754114 PECOS PAC ID: 0547510760 Enrollment ID: I20231027001337 |
Allied Health Systems Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 790 Frank Cochran Dr, Suite 111, Hinesville, GA 31313 Phone: 912-368-3868 | |
Hinesville Faimly Care Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 502 East General Stewart Way Suite A, Hinesville, GA 31313 Phone: 912-368-4169 Fax: 478-625-3667 | |
Liberty Regional Medical Center-walk-in Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 462 Elma G Miles Pkwy, Hinesville, GA 31313 Phone: 912-369-9310 Fax: 912-877-3102 | |
Bryan Medical Associates,inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 740 E General Stewart Way, Suite 103, Hinesville, GA 31313 Phone: 912-876-5452 | |
Hinesville Family Care Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 502 E General Stewart Way, Hinesville, GA 31313 Phone: 912-368-4169 Fax: 912-368-5667 | |
Diversity Health Center Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 502 E General Stewart Way Ste A, Hinesville, GA 31313 Phone: 912-318-3947 Fax: 912-877-0189 | |
Liberty Family Medicine Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 455 S.main Street Ste 104, Hinesville, GA 31313 Phone: 912-876-5644 Fax: 912-408-3457 |