NPIMap

Organization Active NPI

Southern Pain Institute, PC

  • Interventional Pain Medicine Physician
  • Peachtree City, GA
National Provider Identifier
1336232958
Registry record updated Jul 27, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
License
045425 Issued in GA
Legal business name
SOUTHERN PAIN INSTITUTE, PC
Practice address
1975 Highway 54 W
Suite 100
Peachtree City, GA 30269-4794
Phone
(770) 632-3730
Fax
(770) 632-3731
NPI assigned
Oct 2, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2015

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

Authorized official

Name
Dr. Anthony Thaddeus Clavo Sr., M.D.NPI 1851447890
Title
President
Phone
(770) 632-3730

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Pain Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208VP0014X 045425 GA Primary

Addresses

Primary practice location

1975 Highway 54 W
Suite 100
Peachtree City, GA 30269-4794

Mailing address

1975 Highway 54 W
Suite 100
Peachtree City, GA 30269-4794
Phone (770) 632-3730

Other names 1

  • Southern Pain & Diagnostics Institute Other name

National Provider Directory

National Provider Directory

Locations

1975 Highway 54 W
Ste 100
Peachtree City, GA 30269
Phone (678) 888-5060

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1437955200000",
    "number": "1336232958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1975 HIGHWAY 54 W",
            "address_2": "SUITE 100",
            "city": "PEACHTREE CITY",
            "state": "GA",
            "postal_code": "302694794",
            "telephone_number": "770-632-3730",
            "fax_number": "770-632-3731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1975 HIGHWAY 54 W",
            "address_2": "SUITE 100",
            "city": "PEACHTREE CITY",
            "state": "GA",
            "postal_code": "302694794",
            "telephone_number": "770-632-3730",
            "fax_number": "770-632-3731"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN PAIN INSTITUTE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-02",
        "last_updated": "2015-07-27",
        "status": "A",
        "authorized_official_last_name": "CLAVO",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "THADDEUS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-632-3730",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Sr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "GA",
            "license": "045425",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern Pain & Diagnostics Institute",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Peachtree City, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 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.