Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Pca Interventional Spine at Fayette, LLC

Organization Ambulatory Surgical Clinic/Center · NPI 1447791074

Pca Interventional Spine at Fayette, LLC is an Ambulatory Surgical Clinic/Center in Fayetteville, Georgia. Licensed in Georgia. Registered with an NPI since 2017.

Licensed in
GA
In the registry since
2017
Specialties on file
2
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

1233 Highway 54 W Ste 205
Fayetteville, GA 30214-4542
Phone: (404) 351-7654
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Pain Clinic/Center (primary) Taxonomy 261QP3300X
Ambulatory Surgical Clinic/Center Taxonomy 261QA1903X · Licence IN PROCESS (GA)

Record details

NPI number1447791074
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Rodrigo Duralde — Owner · (404) 351-7654
NPI enumeratedMarch 15, 2017
Last updated in NPPESFebruary 20, 2026
Certification dateFebruary 20, 2026
Mailing addressPo Box 40061, Belfast, ME 04915-1237

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