NPIMap

Organization Active NPI

Southern Pain Institute, PC

Doing business as Southern Spine & Pain Institute

  • Specialist
  • Atlanta, GA
National Provider Identifier
1639584378
Registry record updated Jun 20, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
045425 Issued in GA
Legal business name
SOUTHERN PAIN INSTITUTE, PC
Doing business as
Southern Spine & Pain Institute
Practice address
3886 Princeton Lakes Way SW
Ste 240
Atlanta, GA 30331-5511
Phone
(770) 632-3730
Fax
(770) 632-3731
NPI assigned
Jun 20, 2014
Last updated
Jun 20, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2014

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.
Title
President/Owner
Phone
(770) 632-3730

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 045425 GA Primary

Addresses

Primary practice location

3886 Princeton Lakes Way SW
Ste 240
Atlanta, GA 30331-5511

Mailing address

PO Box 740209
Lockbox Dept 40257
Atlanta, GA 30374-0209
Phone (770) 632-3730

Other names 1

  • Southern Spine & 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.

NPI Registry JSON

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

{
    "created_epoch": "1403222400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403222400000",
    "number": "1639584378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 740209",
            "address_2": "LOCKBOX DEPT 40257",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303740209",
            "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": "3886 PRINCETON LAKES WAY SW",
            "address_2": "STE 240",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303315511",
            "telephone_number": "770-632-3730",
            "fax_number": "770-632-3731"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN PAIN INSTITUTE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-20",
        "last_updated": "2014-06-20",
        "status": "A",
        "authorized_official_last_name": "CLAVO",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "THADDEUS",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "770-632-3730",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Sr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "GA",
            "license": "045425",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern Spine & Pain Institute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jun 20, 2014; 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.