BACK TO LIFE MEDICAL GROUP, LLC (NPI# 1346526530) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1346526530 |
| Entity Type | Organization |
| Organization Name | BACK TO LIFE MEDICAL GROUP, LLC |
| Other Organization Name | GEORGIA PAIN TREATMENT CENTERS |
| Practice Address |
557 Riverstone Pkwy Suite 140 Canton GA 30114-5223 |
| Practice Telephone | 7703452000 |
| Practice Fax Number | 7703454524 |
| Mailing Telephone | 7703452000 |
| Mailing Fax Number | 7703454524 |
| Enumeration Date | 2011-11-01 |
| Last Update Date | 2015-06-22 |
| Authorized Official Name | SATISH CUDDAPAH (MEDICAL DIRECTOR) |
| Authorized Official Telephone | 7703452000 |
| Authorized Official Credential | MD |
| Is Organization Subpart | Y |
| Parent Organization Name | BACK TO LIFE MEDICAL GROUP, LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332900000X | Non-Pharmacy Dispensing Site | Suppliers |
| Other Name | Type Code |
|---|---|
| Georgia Pain Treatment Centers | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396987152 | Back To Life Medical Group, LLC | Family Medicine | 557 Riverstone Pkwy, Suite 140, Canton, GA 30114-5223 | 2009-03-25 |
| Street Address |
557 RIVERSTONE PKWY SUITE 140 |
| City | CANTON |
| State | GA |
| Zip Code | 30114-5223 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407974538 | Eric Anthony Cavaciuti | Chiropractor | 557 Riverstone Pkwy, Suite 140, Canton, GA 30114-5223 | 2007-03-27 |
| 1518228022 | North Georgia Health Care Group LLC | Clinical Medical Laboratory | 557 Riverstone Pkwy, Suite 140, Canton, GA 30114-5223 | 2012-05-31 |
| 1396987152 | Back To Life Medical Group, LLC | Family Medicine | 557 Riverstone Pkwy, Suite 140, Canton, GA 30114-5223 | 2009-03-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619516093 | Wickshire Canton Opco LLC | Assisted Living Facility | 125 Riverstone Terrace, Canton, GA 30114 | 2020-01-02 |
| 1154803583 | Alixandra Nicole Flournoy | Physical Therapist | 131 Holly Street, Canton, GA 30114 | 2018-09-01 |
| 1588157341 | Provident Group - Canton Cove Properties LLC | Alzheimer Center (Dementia Center) | 1100 Reinhardt College Parkway, Canton, GA 30114 | 2018-06-07 |
| 1003233107 | Heartland Dental Care of Georgia | Dentist | 3237 Sixes Rd, Canton, GA 30114 | 2014-03-26 |
| 1730510959 | Joseph Optical | Eyewear Supplier (Equipment, not the service) | 1455 Riverstone Pkwy Suite 110, Canton, GA 30114 | 2013-12-13 |
| 1629313036 | Ramona Morton Rasmussen | Occupational Therapist | 200 Riverstone Drive, Suite B, Canton, GA 30114 | 2012-12-11 |
| 1902154875 | Yong Qiao Luo | Acupuncturist | 200 Oakside Lane, Suite D, Canton, GA 30114 | 2012-08-26 |
| 1215294350 | Christina Lynn Hernandez | Pediatrics | 1558 Riverstone Pkwy Ste 100, Canton, GA 30114 | 2012-04-13 |
| 1558638981 | Stephen E Byrd | Counselor | 191 Lamar Haley Pkwy., Canton, GA 30114 | 2011-11-30 |
| 1073807855 | Sheri Sullins Buckley | Nurse Practitioner | 120 Oakside Ct Ste H, Canton, GA 30114 | 2011-06-08 |
| Find all providers in zip 30114 | ||||
| Taxonomy Code | 332900000X |
| Grouping | Suppliers |
| Classification | Non-Pharmacy Dispensing Site |
| A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.) |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992199665 | Ehi Pharmacy Solutions, LLC | Non-Pharmacy Dispensing Site | 132 Riverstone Ter, Ste. 101, Canton, GA 30114-1703 | 2015-03-20 |
| 1801107610 | Health Street Pllc | Non-Pharmacy Dispensing Site | 7321 N Lilley Rd, Canton, MI 48187-2457 | 2010-06-25 |
| 1154592525 | Phoenix Rising Behavioral Healthcare and Recovery, Inc | Non-Pharmacy Dispensing Site | 1930 Fremont Pl Sw, Canton, OH 44706-1551 | 2008-03-13 |
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| 1659929339 | Ankle and Foot Centers of Georgia, LLC | Non-Pharmacy Dispensing Site | 1975 Highway 54 W Ste 200, Peachtree City, GA 30269-4794 | 2019-08-27 |
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| 1225686991 | Ankle and Foot Centers of Georgia, LLC | Non-Pharmacy Dispensing Site | 1819 Peachtree Rd Ne Ste 103, Atlanta, GA 30309-1848 | 2019-08-27 |
| 1265995724 | Georgia Urology Pa | Non-Pharmacy Dispensing Site | 5900 Hillandale Dr Ste 200, Lithonia, GA 30058-3858 | 2019-04-11 |
| 1861980955 | Wellstreet of Georgia PC | Non-Pharmacy Dispensing Site | 4763 Atlanta Hwy Ste 420, Loganville, GA 30052-6788 | 2018-04-25 |
| 1184111338 | Wellstreet of Georgia PC | Non-Pharmacy Dispensing Site | 10945 State Bridge Rd Ste 901, Alpharetta, GA 30022-8164 | 2018-04-13 |
| 1538666854 | Wellstreet of Georgia PC | Non-Pharmacy Dispensing Site | 1575 Mount Vernon Rd, Dunwoody, GA 30338-4146 | 2018-04-12 |
| 1811494156 | Wellstreet of Georgia PC | Non-Pharmacy Dispensing Site | 6063 Peachtree Pkwy Ste 210a, Peachtree Corners, GA 30092-3303 | 2018-04-12 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.