NPIMap

Organization Active NPI

Southern Pain and Spine Associates LLC

  • Interventional Pain Medicine Physician
  • Gainesville, GA
National Provider Identifier
1336744770
Registry record updated Feb 20, 2026
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
601 Broad St SE Ste B
Gainesville, GA 30501-3718
Phone
(678) 971-4167
Fax
(833) 989-2501
NPI assigned
Dec 3, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2026

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

Authorized official

Name
Ankur Bharat Patel, MDNPI 1780971994
Title
Ceo/ Owner Partner
Phone
(678) 971-4167

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207L00000X
Interventional Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0014X Primary
Clinic/Center 261Q00000X
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

601 Broad St SE Ste B
Gainesville, GA 30501-3718

Mailing address

1233 Highway 54 W Ste 200
Fayetteville, GA 30214-4542
Phone (678) 971-4167

Other practice location 1

3579 Highway 138 SE Ste 204
Stockbridge, GA 30281-6807
Phone (678) 971-4167

Other practice location 2

1150 Hammond Drive
Bldg E, Suite 40
Atlanta, GA 30328
Phone (678) 971-4167

Other practice location 3

1101 Old Philadelphia Rd Ste G100
Jasper, GA 30143-4044
Phone (678) 971-4167

Other practice location 4

1500 Oglethorpe Ave Bldg 500 Ste B
Athens, GA 30606-2184
Phone (678) 971-4167

Other practice location 5

3231 Hwy 34E Ste C
Newnan, GA 30265
Phone (678) 971-4167

Other practice location 6

1800 Peachtree St NW Ste 750
Atlanta, GA 30309-2530
Phone (678) 971-4167

Other practice location 7

1233 Highway 54 W Ste 200
Fayetteville, GA 30214-4542
Phone (678) 971-4167

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210120000336 GA Part B Supplier - Clinic/Group Practice 7517370299 Receives reassigned benefits from 21 practitioners
Practice locations: Stockbridge, GA; Newnan, GA; Jasper, GA; Gainesville, GA; Atlanta, GA; Athens, GA; Fayetteville, GA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

1500 Oglethorpe Ave
Ste A
Athens, GA 30606
Phone (678) 800-0099

1500 Oglethorpe Ave
Ste 500B
Athens, GA 30606
Phone (706) 548-5833

1240 Highway 54 W
Ste 600
Fayetteville, GA 30214

601 Broad St SE
Ste B
Gainesville, GA 30501
Phone (678) 989-1515

601 Broad St SE
Gainesville, GA 30501
Phone (678) 640-4679

1101 Old Philadelphia Rd
Ste G
Jasper, GA 30143

1101 Old Philadelphia Rd
#G100
Jasper, GA 30143

3231 Highway 34 E
Newnan, GA 30265

3579 Highway 138 SE
Ste 204
Stockbridge, GA 30281
Phone (404) 996-9500

Practitioners & affiliated clinicians

Practitioners 21

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

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1606953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1771545600000",
    "number": "1336744770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1233 HIGHWAY 54 W STE 200",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302144542",
            "telephone_number": "678-971-4167",
            "fax_number": "883-428-2629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 BROAD ST SE STE B",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305013718",
            "telephone_number": "678-971-4167",
            "fax_number": "833-989-2501"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3579 Highway 138 SE Ste 204",
            "address_purpose": "LOCATION",
            "city": "Stockbridge",
            "state": "GA",
            "postal_code": "302816807",
            "country_code": "US",
            "telephone_number": "678-971-4167",
            "fax_number": "833-428-2634",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1150 Hammond Drive",
            "address_2": "Bldg E, Suite 40",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "30328",
            "country_code": "US",
            "telephone_number": "678-971-4167",
            "fax_number": "833-972-4825",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1101 Old Philadelphia Rd Ste G100",
            "address_purpose": "LOCATION",
            "city": "Jasper",
            "state": "GA",
            "postal_code": "301434044",
            "country_code": "US",
            "telephone_number": "678-971-4167",
            "fax_number": "706-253-7060",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1500 Oglethorpe Ave Bldg 500 Ste B",
            "address_purpose": "LOCATION",
            "city": "Athens",
            "state": "GA",
            "postal_code": "306062184",
            "country_code": "US",
            "telephone_number": "678-971-4167",
            "fax_number": "678-971-4168",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3231 Hwy 34E Ste C",
            "address_purpose": "LOCATION",
            "city": "Newnan",
            "state": "GA",
            "postal_code": "30265",
            "country_code": "US",
            "telephone_number": "678-971-4167",
            "fax_number": "833-989-2501",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1800 Peachtree St NW Ste 750",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303092530",
            "country_code": "US",
            "telephone_number": "678-971-4167",
            "fax_number": "833-428-2599",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1233 Highway 54 W Ste 200",
            "address_purpose": "LOCATION",
            "city": "Fayetteville",
            "state": "GA",
            "postal_code": "302144542",
            "country_code": "US",
            "telephone_number": "678-971-4167",
            "fax_number": "833-428-2629",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTHERN PAIN AND SPINE ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-03",
        "last_updated": "2026-02-20",
        "certification_date": "2026-02-20",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "ANKUR",
        "authorized_official_middle_name": "BHARAT",
        "authorized_official_title_or_position": "CEO/ OWNER PARTNER",
        "authorized_official_telephone_number": "678-971-4167",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gainesville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.