Organization · Type 2 NPI

Back To Life Medical Group, LLC

Non-Pharmacy Dispensing Site · Canton, GA

NPI number 1346526530 Active

Practice location

557 Riverstone Pkwy, Suite 140
Canton, GA 30114-5223

Call (770) 345-2000 Map

Fax (770) 345-4524

Specialties and licenses

Taxonomy	Code	License
Non-Pharmacy Dispensing Site Primary	332900000X	None listed

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.)

3 other providers at this address

Other non-pharmacy dispensing site providers in Canton

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NPI record

NPI: 1346526530
Entity type: Organization (Type 2)
Issued: Nov 1, 2011
Last updated: Jun 22, 2015
Status: Active
Subpart: Yes of Back To Life Medical Group, LLC

Other names

<unavail>
Georgia Pain Treatment Centers · doing business as

Authorized official

Satish Cuddapah, MD
Medical Director
(770) 345-2000

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1346526530

Back To Life Medical Group, LLC's National Provider Identifier is 1346526530, issued on Nov 1, 2011. The primary taxonomy on file is Non-Pharmacy Dispensing Site (332900000X), and the practice location is in Canton, GA. The record was last updated on Jun 22, 2015.