Southern Crescent Pain Management LLC

Primary specialty

Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X

License

045566 Issued in GA

Legal business name

SOUTHERN CRESCENT PAIN MANAGEMENT LLC

Practice address

147 N Park TRL
Stockbridge, GA 30281-7373

Phone

(678) 284-1232

Fax

(678) 284-1296

NPI assigned

Jan 8, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Olufemi Ayotunde Ogunyemi, MD

Title

Medical Director

Phone

(678) 284-1232

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1199750400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199750400000",
    "number": "1831374982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "147 N PARK TRL",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302817373",
            "telephone_number": "678-284-1232",
            "fax_number": "678-284-1296"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "147 N PARK TRL",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302817373",
            "telephone_number": "678-284-1232",
            "fax_number": "678-284-1296"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN CRESCENT PAIN MANAGEMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-08",
        "last_updated": "2008-01-08",
        "status": "A",
        "authorized_official_last_name": "OGUNYEMI",
        "authorized_official_first_name": "OLUFEMI",
        "authorized_official_middle_name": "AYOTUNDE",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "678-284-1232",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "GA",
            "license": "045566",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Southern Crescent Care,LLC
• Southern Crescent Endoscopy Suite, PC
• Southern Crescent ENT, P.C.
• Southern Crescent Medical Center, LLC
• Southern Crescent Nephrology, PC
• Southern Crescent Pediatrics PC
• Southern Crescent Plastic Surgery ASC
• Southern Crescent Plastic Surgery, PC
• Southern Crescent Women'S Health Specialists
• Southern Crescent Womens Health Specialists at Eagle'S Landing

• Interventional Pain Medicine Physician in Stockbridge, GA
• Providers in Stockbridge, GA by specialty
• Interventional Pain Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2008; 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.