NPIMap

Organization Active NPI

Southern Pain and Spine Associates, LLC

  • Durable Medical Equipment & Medical Supplies
  • Atlanta, GA
National Provider Identifier
1548059835
Registry record updated Jan 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
SOUTHERN PAIN AND SPINE ASSOCIATES, LLC
Practice address
1150 Hammond Dr Ste 50
Atlanta, GA 30328-7500
Phone
(678) 971-4167
Fax
(833) 989-2501
NPI assigned
May 2, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2026

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

Authorized official

Name
Josephine Evangelista
Title
Credentialing Manager
Phone
(404) 408-2144

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Pain Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208VP0014X
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

1150 Hammond Dr Ste 50
Atlanta, GA 30328-7500

Mailing address

1233 Highway 54 W Ste 207
Fayetteville, GA 30214-4643
Phone (678) 971-4167

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20251104001158 GA DME Supplier - Physician - Interventional Pain Management 7517370299 Practice locations: Atlanta, 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
Tax ID family
Southern Pain and Spine Associates LLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

1233 Highway 54 W
Ste 207
Fayetteville, GA 30214

1233 Highway 54 W
Ste 200
Fayetteville, GA 30214
Phone 6789714167160

303 Smith St
Fl Second
Lagrange, GA 30240
Phone (678) 800-0099

Practitioners 19

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

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1746144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1767571200000",
    "number": "1548059835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1233 HIGHWAY 54 W STE 207",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302144643",
            "telephone_number": "678-971-4167",
            "fax_number": "833-989-2501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 HAMMOND DR STE 50",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303287500",
            "telephone_number": "678-971-4167",
            "fax_number": "833-989-2501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN PAIN AND SPINE ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-05-02",
        "last_updated": "2026-01-05",
        "certification_date": "2026-01-05",
        "status": "A",
        "authorized_official_last_name": "EVANGELISTA",
        "authorized_official_first_name": "JOSEPHINE",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "404-408-2144"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 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.