GARY GEORGE THEOFILIS (NPI# 1558672014) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558672014 |
| Entity Type | Individual |
| Full Name | GARY GEORGE THEOFILIS |
| Credential | DO, MBA, DABAM |
| Practice Address |
6125 Broadwater Trl Cumming GA 30040-9521 |
| Practice Telephone | (412) 477-4493 |
| Mailing Telephone | (412) 477-4493 |
| Enumeration Date | 2010-06-29 |
| Last Update Date | 2017-05-14 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207LA0401X |
Anesthesiology Specialization: Addiction Medicine |
OS01718 | PA | Allopathic & Osteopathic Physicians |
| N | 207LA0401X |
Anesthesiology Specialization: Addiction Medicine |
74400 | GA | Allopathic & Osteopathic Physicians |
| N | 208VP0014X |
Pain Medicine Specialization: Interventional Pain Medicine |
OS01718 | PA | Allopathic & Osteopathic Physicians |
| Y | 208VP0014X |
Pain Medicine Specialization: Interventional Pain Medicine |
74400 | GA | Allopathic & Osteopathic Physicians |
| Street Address |
6125 BROADWATER TRL |
| City | CUMMING |
| State | GA |
| Zip Code | 30040-9521 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427684729 | Am Nollenberger Counseling | Counselor | 327 Dahlonega Street Ste 901 A, Cumming, GA 30040 | 2020-03-18 |
| 1497388904 | Ben Allen Sanders | Pharmacist | Kroger Pharmacy 627, 5550 Bethelview Road, Cumming, GA 30040 | 2020-02-13 |
| 1407415615 | Jacqueline Small | Nurse Practitioner | 407 W Maple St # 101, Cumming, GA 30040 | 2019-06-11 |
| 1336706316 | Mary Kathleen Hesidence | Nurse Practitioner | 81 Northside Dr, #100, Dawsonville, GA 30040 | 2019-05-24 |
| 1851958334 | North Georgia Pathology | Pathology | 4150 Deputy Bill Cantrell Memorial Rd Suite 200, Cumming, GA 30040 | 2019-05-21 |
| 1598320087 | Emily Rebecca Downs | Physician Assistant | 3970 Deputy Bill Cantrell Memorial Road Ste 150, Cumming, GA 30040 | 2019-05-09 |
| 1215490057 | Shine Speech Language Therapy LLC | Speech-Language Pathologist | 107 Pilgrim Village Dr Suite 400, Cumming, GA 30040 | 2019-04-09 |
| 1417430075 | Ashley Michelle Nollenberger | Counselor | 327 Dahlonega Street, Ste 901 A, Cumming, GA 30040 | 2018-09-10 |
| 1518445410 | Village Pediatrics At Vickery | Pediatrics | 7185 Colfax Aveune, Suite 200, Cumming, GA 30040 | 2018-08-02 |
| 1306339841 | Fukuzato Eyecare, Inc | Optometrist | 3670 Hutchinson Rd Ste A&b, Cumming, GA 30040 | 2018-06-09 |
| Find all providers in zip 30040 | ||||
| Taxonomy Code | 208VP0014X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pain Medicine |
| Specialization | Interventional Pain Medicine |
| Interventional Pain Medicine is the discipline of medicine devoted to the diagnosis and treatment of pain and related disorders principally with the application of interventional techniques in managing subacute, chronic, persistent, and intractable pain, independently or in conjunction with other modalities of treatment. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891302998 | Apollo Spine and Pain Center | Pain Medicine | 4415 Front Nine Dr, Cumming, GA 30041-6063 | 2020-09-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235756792 | Interventional Spine and Pain Management Center, PC | Pain Medicine | 2100 Central Ave Ste 6, Augusta, GA 30904-6709 | 2020-07-01 |
| 1902433147 | Sun Pain Institute LLC | Pain Medicine | 836 E 65th St Ste 38, Savannah, GA 31405-4495 | 2020-03-26 |
| 1679107338 | Atlanta Interventional Pain Management, LLC | Pain Medicine | 13190 Highway 92 Ste 120, Woodstock, GA 30188-4406 | 2020-03-02 |
| 1578193355 | Regenerative Spine and Pain Specialists | Pain Medicine | 874 Lanier Ave W Ste 250, Fayetteville, GA 30214-7662 | 2020-01-22 |
| 1437790839 | Specialty Spine and Pain, PC | Pain Medicine | 1498 Jesse Jewell Pkwy Se Ste D, Gainesville, GA 30501-3874 | 2019-10-07 |
| 1154962165 | Specialty Spine and Pain, PC | Pain Medicine | 2695 Old Winder Hwy Ste 150, Braselton, GA 30517-6076 | 2019-10-01 |
| 1659912665 | Specialty Spine and Pain, PC | Pain Medicine | 5005a Lanier Islands Pkwy Ste 100, Buford, GA 30518-1802 | 2019-10-01 |
| 1114578515 | Interventional Spine and Pain Management Center, PC | Pain Medicine | 6002 Highway 53 E Ste 110, Dawsonville, GA 30534-6227 | 2019-09-26 |
| 1477106771 | Spine Center of Southeast Georgia LLC | Pain Medicine | 52a Lindsey Lane, Kingsland, GA 31548-6855 | 2019-07-17 |
| 1467014936 | Interventional Spine and Pain Management Center, PC | Pain Medicine | 6920 Mcginnis Ferry Rd Ste 360b, Suwanee, GA 30024-6672 | 2019-07-03 |
| 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.