Southern Comfort Pain & Wellness

Primary specialty

Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X

Legal business name

SOUTHERN COMFORT PAIN & WELLNESS

Practice address

151 Lee Byrd Rd
Loganville, GA 30052-2310

Phone

(678) 587-5993

Fax

(678) 587-5997

NPI assigned

Mar 30, 2022

Organization subpart

No

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

Authorized official

Name

Michael Kissel, MDNPI 1356542799

Title

Owner

Phone

(770) 633-5513

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 2

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

• Michael T Kissel, M.D.

  • Pain Medicine (Anesthesiology) Physician
  • Loganville, GA
  • NPI 1356542799
  Medicare reassignment Care Compare group NPD Authorized official
• Tiaya Welsh, FNP-BC, MSN, APRN

  • Family Nurse Practitioner
  • Monroe, GA
  • NPI 1366978314
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1648598400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653091200000",
    "number": "1720728454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 LEE BYRD RD",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300522310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "151 LEE BYRD RD",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300522310",
            "telephone_number": "678-587-5993",
            "fax_number": "678-587-5997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN COMFORT PAIN & WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-30",
        "last_updated": "2022-05-21",
        "certification_date": "2022-05-21",
        "status": "A",
        "authorized_official_last_name": "KISSEL",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-633-5513",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Lamrot Solomon, DMD
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• Yolanda Velez Sostre
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• Sovereign Rehabilitation of Georgia, LLC
• Spectrum Early Intervention Center LLC
• Susan Fleming Spissman, LPC
• SRG Inc
• Alicia St Vincent

• Pain Medicine (Anesthesiology) Physician in Loganville, GA
• Providers in Loganville, GA by specialty
• Pain Medicine (Anesthesiology) Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2022; 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.