Provider Type Icon

SOUTHERN PAIN INSTITUTE PC NPI 1639584378


NPI Information

NPI: 1639584378
Provider Name: SOUTHERN PAIN INSTITUTE, PC

Doing Business As: SOUTHERN SPINE & PAIN INSTITUTE

Classification: Specialist - 174400000X
Entity Type: Organization
Address:
3886 PRINCETON LAKES WAY SW
STE 240
ATLANTA, GA
ZIP 30331
Phone: (770) 632-3730
Get Directions

SOUTHERN PAIN INSTITUTE, PC is a specialist in Atlanta, GA. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. SOUTHERN PAIN INSTITUTE, PC NPI is 1639584378. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Southern Spine & Pain Institute.

The provider's business location address is:

3886 PRINCETON LAKES WAY SW
STE 240
ATLANTA, GA
ZIP 30331-511
Phone: (770) 632-3730
Fax: (770) 632-3731

The provider's authorized official is Anthony Thaddeus Clavo .
The authorized official title is President/owner and has the following contact phone number (770) 632-3730.

The enumeration date for this NPI number is 6/20/2014 and was last updated on 6/20/2014.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1174400000XSpecialist045425GEORGIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1208VP0014XOTHERGEORGIAPAIN MEDICINE-INTERVENTIONAL PAIN MEDICINE TAXONOMY
2GRP6066OTHERGEORGIAMEDICARE ID
3G72848MEDICARE UPINGEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.