Southern Pain Institute P C

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHRE009658 Issued in GA

Legal business name

SOUTHERN PAIN INSTITUTE P C

Practice address

1501 Milstead Rd NE Ste 140
Conyers, GA 30012-3849

Phone

(770) 632-3730

Fax

(770) 632-3731

NPI assigned

Jul 22, 2010

Organization subpart

No

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

Authorized official

Name

Lynn Clavo

Title

Pic

Phone

(770) 632-3730

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Southern Pain Institute Doing business as

Tax ID family

Southern Pain Institute PC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

• Southern Pain Institute PC

  • Interventional Pain Medicine Physician
  • Conyers, GA
  • NPI 1609913318
  NPD tax ID
• Southern Pain Institute, PC

  • Specialist
  • Atlanta, GA
  • NPI 1639584378
  NPD tax ID

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

{
    "created_epoch": "1279756800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424736000000",
    "number": "1174836845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1975 HIGHWAY 54 W",
            "address_2": "STE 100",
            "city": "PEACHTREE CITY",
            "state": "GA",
            "postal_code": "302694794",
            "telephone_number": "770-313-3380",
            "fax_number": "770-632-3731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 MILSTEAD RD NE STE 140",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300123849",
            "telephone_number": "770-632-3730",
            "fax_number": "770-632-3731"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN PAIN INSTITUTE P C",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-22",
        "last_updated": "2015-02-24",
        "status": "A",
        "authorized_official_last_name": "CLAVO",
        "authorized_official_first_name": "LYNN",
        "authorized_official_title_or_position": "PIC",
        "authorized_official_telephone_number": "770-632-3730"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "GA",
            "license": "PHRE009658",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003100329A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2125516",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern Pain Institute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Southern Pain Institute PC
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• Community/Retail Pharmacy in Conyers, GA
• Providers in Conyers, GA by specialty
• Community/Retail Pharmacy in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2015; 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.