NPIMap

Organization Active NPI

Southern Pain Institute P C

Doing business as Southern Pain Institute

  • Community/Retail Pharmacy
  • Conyers, GA
National Provider Identifier
1174836845
Registry record updated Feb 24, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PHRE009658 Issued in GA
Legal business name
SOUTHERN PAIN INSTITUTE P C
Doing business as
Southern Pain Institute
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
Last updated
Feb 24, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2015

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

Authorized official

Name
Lynn ClavoNPI 1891468179
Title
Pic
Phone
(770) 632-3730

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X PHRE009658 GA Primary

Addresses

Primary practice location

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

Mailing address

1975 Highway 54 W
Ste 100
Peachtree City, GA 30269-4794
Phone (770) 313-3380

Other names 1

  • Southern Pain Institute Doing business as

National Provider Directory

National Provider Directory
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.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern Pain Institute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Conyers, GA

Sources for this page

  • 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.