Southside Medical & Physical Therapy, LLC

Primary specialty

Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X

License

054590 Issued in GA

Legal business name

SOUTHSIDE MEDICAL & PHYSICAL THERAPY, LLC

Practice address

1415 Highway 85 N
Suite 310-314
Fayetteville, GA 30214-4035

Phone

(866) 476-8913

NPI assigned

May 14, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Steven Lobel

Title

Medical Director

Phone

(866) 476-8913

Specialties & licenses 1

Addresses

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Caryn Ann Grzesiakowski, DC

  • Chiropractor
  • Jonesboro, GA
  • NPI 1205050259
  NPD (past)
• Beth J Dubois, D.C.

  • Orthopedic Chiropractor
  • Oswego, NY
  • NPI 1073604450
  NPD (past)
• Lorraine Ficocelli, DC

  • Chiropractor
  • Lancaster, OH
  • NPI 1013935907
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193616000000",
    "number": "1063628675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1415 HIGHWAY 85 N",
            "address_2": "SUITE 310-314",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302144035",
            "telephone_number": "866-476-8913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 HIGHWAY 85 N",
            "address_2": "SUITE 310-314",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302144035",
            "telephone_number": "866-476-8913"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHSIDE MEDICAL & PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-14",
        "last_updated": "2007-10-29",
        "status": "A",
        "authorized_official_last_name": "LOBEL",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "866-476-8913",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "GA",
            "license": "054590",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Southern Crescent Physicians Group, Inc.
• Southern Crescent Women'S Healthcare PC
• Southern Neighbor Medical Transport LLC
• Southern Pain Institute P C
• Southern Roots ABA LLC
• Southside Speech Solutions, LLC
• Sparkling Smiles Fayetteville LLC
• Speak With Ease, LLC
• Dana Scott Spears, PHD
• Speech Assessment Center, Inc.

• Interventional Pain Medicine Physician in Fayetteville, GA
• Providers in Fayetteville, GA by specialty
• Interventional Pain Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.