NPIMap

Organization Active NPI

Southern Pain and Spine Associates LLC

  • Interventional Pain Medicine Physician
  • Jasper, GA
National Provider Identifier
1093469355
Registry record updated May 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
Legal business name
SOUTHERN PAIN AND SPINE ASSOCIATES LLC
Practice address
1101 Old Philadelphia Rd Ste G100
Jasper, GA 30143-4044
Phone
(678) 971-4167
Fax
(833) 989-2501
NPI assigned
Feb 7, 2022
Organization subpart
Yes
Parent organization
SOUTHERN PAIN AND SPINE ASSOCIATES, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 25, 2022

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

Authorized official

Name
Hamish Patel
Title
Coo
Phone
(470) 628-9203

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Pain Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208VP0014X Primary

Addresses

Primary practice location

1101 Old Philadelphia Rd Ste G100
Jasper, GA 30143-4044

Mailing address

PO Box 28415
Belfast, ME 04915-2036
Phone (888) 488-8289

Other identifiers 1

IdentifierTypeStateIssuer
72139OtherGAGCMB

Other names 1

  • Southern Pain and Spine - Jasper Other name

National Provider Directory

National Provider Directory
Tax ID family
Southern Pain and Spine Associates LLC5 organizations share this tax ID, including this one
Part of
Southern Pain and Spine Associates LLC

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1101 Old Philadelphia Rd
Ste G100
Jasper, GA 30143

Practitioners 31

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

View all 31

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2248497Southern Pain and Spine - Jasper1101 Old Philadelphia Road, Suite G100, Jasper, GA 30143Certificate of waiverJan 12, 2028

NPI Registry JSON

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

{
    "created_epoch": "1644192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653436800000",
    "number": "1093469355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 28415",
            "city": "BELFAST",
            "state": "ME",
            "postal_code": "049152036",
            "telephone_number": "888-488-8289",
            "fax_number": "502-919-9780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 OLD PHILADELPHIA RD STE G100",
            "city": "JASPER",
            "state": "GA",
            "postal_code": "301434044",
            "telephone_number": "678-971-4167",
            "fax_number": "833-989-2501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN PAIN AND SPINE ASSOCIATES LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHERN PAIN AND SPINE ASSOCIATES, LLC",
        "enumeration_date": "2022-02-07",
        "last_updated": "2022-05-25",
        "certification_date": "2022-05-25",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "HAMISH",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "470-628-9203"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GCMB",
            "identifier": "72139",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern Pain and Spine - Jasper",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Southern Pain and Spine - Jasper",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Jasper, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.