Lakeside Pain Center, P.C.

Key facts

NPI: 1477566727
Entity type: Organization (NPI type 2)
Primary specialty: Interventional Pain Medicine Physician 208VP0014X
License: 042215 (GA)
Legal business name: LAKESIDE PAIN CENTER, P.C.
Practice address: 701 E US Highway 80 Ste C
Bloomingdale, GA 31302-0078
Phone: (478) 475-9220
Fax: (478) 475-9201
NPI assigned: Aug 15, 2006
Organization subpart: No

Authorized official

Name: Dwayne Lee Clay
Title: MD
Phone: (478) 475-9220

Practitioners 1

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

Dwayne Lee Clay, M.D. Interventional Pain Medicine Physician · Macon, GA · NPI 1003829433

Medicare reassignment NPD GA · PHYSICAL MEDICINE & REHABILITATION

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA number	Laboratory	Certificate	Expires
11D2336505	Lakeside Pain Center, PC 701 E US Highway 80, Suite C, Bloomingdale, GA 31302	Certificate of waiver	Jan 5, 2028

Medicare participation

Medicare fee-for-service enrollment: Enrolled in GA

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20150512002974	GA	Part B Supplier - Clinic/Group Practice	6901125095	Receives reassigned benefits from 1 practitioner Practice locations: Macon, GA; Bloomingdale, GA

National Provider Directory

Locations

701 E US Highway 80
Ste C
Bloomingdale, GA 31302
Phone (478) 475-9220

125 Plantation Centre Dr S
Ste 750A
Macon, GA 31210
Phone (478) 475-9220

Interoperability endpoints

FHIR API: https://fhir-myrecord.cerner.com/r4/9d6b5484-5a6e-4277-a298-c488b306f27b/

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Physical Medicine & Rehabilitation Physician Group: 193200000X MULTI-SPECIALTY GROUP	208100000X	042215	GA
Pain Medicine Physician Group: 193200000X MULTI-SPECIALTY GROUP	208VP0000X	042215	GA
Interventional Pain Medicine Physician Group: 193200000X MULTI-SPECIALTY GROUP	208VP0014X	042215	GA	Yes

Addresses

Primary practice location

701 E US Highway 80 Ste C
Bloomingdale, GA 31302-0078

Mailing address

701 E US Highway 80 Ste C
Bloomingdale, GA 31302-0078
Phone (478) 475-9220

Other practice location 1

125 Plantation Centre Dr S Ste 750A
Macon, GA 31210-2091
Phone (478) 475-9220

Other providers in Bloomingdale, GA

All providers in Bloomingdale, GA · Interventional Pain Medicine Physician in Georgia

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 13, 2026. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Medicare Care Compare provider data (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.