SOUTHERN PAIN INSTITUTE, PC (NPI# 1639584378) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639584378 |
| Entity Type | Organization |
| Organization Name | SOUTHERN PAIN INSTITUTE, PC |
| Other Organization Name | SOUTHERN SPINE & PAIN INSTITUTE |
| Practice Address |
3886 Princeton Lakes Way Sw Ste 240 Atlanta GA 30331-5511 |
| Mailing Address |
Po Box 740209 Lockbox Dept 40257 Atlanta GA 30374-0209 |
| Practice Telephone | 7706323730 |
| Practice Fax Number | 7706323731 |
| Mailing Telephone | 7706323730 |
| Mailing Fax Number | 7706323731 |
| Enumeration Date | 2014-06-20 |
| Last Update Date | 2014-06-20 |
| Authorized Official Name | DR. ANTHONY THADDEUS CLAVO SR. (PRESIDENT/OWNER) |
| Authorized Official Telephone | 7706323730 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | 045425 | GA | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | PAIN MEDICINE-INTERVENTIONAL PAIN MEDICINE TAXONOMY | 208VP0014X | 01 |
| GA | MEDICARE ID | GRP6066 | 01 |
| Other Name | Type Code |
|---|---|
| Southern Spine & Pain Institute | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336232958 | Southern Pain Institute, PC | Pain Medicine | 1975 Highway 54 W, Suite 100, Peachtree City, GA 30269-4794 | 2006-10-02 |
| Street Address |
3886 PRINCETON LAKES WAY SW STE 240 |
| City | ATLANTA |
| State | GA |
| Zip Code | 30331-5511 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710955141 | Felicia L Rhaney | Obstetrics & Gynecology | 3886 Princeton Lakes Way Sw, Suite 160, Atlanta, GA 30331-5511 | 2006-03-10 |
| 1902259641 | Marcia Adelle Edwards | Midwife | 3886 Princeton Lakes Way Sw, Atlanta, GA 30331-5511 | 2016-07-18 |
| 1538546064 | Chantel Karim-williams | Pharmacist | 3886 Princeton Lakes Way Sw, Suite 200, Atlanta, GA 30331-5511 | 2015-05-05 |
| 1316330772 | Trinity Pharmacy Enterprise II LLC | Pharmacist | 3886 Princeton Lakes Way Sw, 180, Atlanta, GA 30331-5511 | 2015-03-10 |
| 1730430802 | Nsh Cancer Institute Professional Service G LLC | Durable Medical Equipment & Medical Supplies | 3886 Princeton Lakes Way Sw, Suite 200, Atlanta, GA 30331-5511 | 2012-09-28 |
| 1316210156 | Prestige Healthcare Atlanta, LLC | Obstetrics & Gynecology | 3886 Princeton Lakes Way Sw, Suite 280, Atlanta, GA 30331-5511 | 2012-02-09 |
| 1104197797 | Life Cycle Ob/gyn, LLC | Obstetrics & Gynecology | 3886 Princeton Lakes Way Sw, Suite 160, Atlanta, GA 30331-5511 | 2012-01-13 |
| 1013215938 | Georgia Cancer Specialists I, PC | Internal Medicine | 3886 Princeton Lakes Way Sw, Suite 200, Atlanta, GA 30331-5511 | 2011-03-01 |
| 1467757492 | Head-to-toe Medical Supplies, LLC | Durable Medical Equipment & Medical Supplies | 3886 Princeton Lakes Way Sw, Suite 140-b, Atlanta, GA 30331-5511 | 2011-01-24 |
| 1457508681 | Providence Foot & Ankle Centers, P.C. Inc. | Podiatrist | 3886 Princeton Lakes Way Sw, Suite 140a, Atlanta, GA 30331-5511 | 2008-08-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861001174 | Whitney Flemister | Social Worker | 3961 Princeton Lakes Way Sw, Atlanta, GA 30331 | 2020-07-23 |
| 1982237400 | Publix Super Markets, Inc. | Durable Medical Equipment & Medical Supplies | 5829 Campbellton Road, S.w, Suite 110, Atlanta, GA 30331 | 2020-02-13 |
| 1295375558 | Drusilla Precious Cudjoe | Behavior Technician | 3800 Camp Creek Parkway Sw, Building 1400, Atlanta, GA 30331 | 2020-01-14 |
| 1497262778 | Champions Pharmacy | Pharmacy | 3886 Princeton Lakes Way Suite 180, Atlanta, GA 30331 | 2018-01-08 |
| 1033629779 | Carmen Ardoin | Counselor | 2636 Martin Luther King Jr. Drive, Suite 12, Atlanta, GA 30331 | 2017-10-09 |
| 1346759974 | Neva R Allison | Nurse Practitioner | 2611 Dayview Ln, Atlanta, GA 30331 | 2017-09-26 |
| 1538678255 | Natalie Mckay | Technician/Technologist | 3915 Cascade Rd, 220, Atlanta, GA 30331 | 2017-09-26 |
| 1700304268 | Tyrone Pipkin | Contractor | 415 Kendrick Terrace Sw, Atlanta, GA 30331 | 2017-09-05 |
| 1073031688 | Kristen Wooldridge | Pharmacist | 3695 Cascade Road, Atlanta, GA 30331 | 2017-09-04 |
| 1548704687 | Advance Pain Management | Health Maintenance Organization | 2950 Stone Hogan Road Connector, Atlanta, GA 30331 | 2016-12-08 |
| Find all providers in zip 30331 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
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|---|---|---|---|---|
| 1265030407 | Sandra W Paul | Specialist | 4185 Glad Morning Dr, Atlanta, GA 30349-3902 | 2020-10-10 |
| 1053926154 | Idoc Virtual Neuro Critical Care LLC | Specialist | 159 E Wesley Rd Ne, Atlanta, GA 30305-3707 | 2020-09-15 |
| 1114489663 | Dr. Behling, LLC | Specialist | 1100 Peachtree St Ne Ste 250, Atlanta, GA 30309-4522 | 2019-04-03 |
| 1376013813 | Quality Therapeutic Massage LLC | Specialist | 423 Tazor St Nw, Atlanta, GA 30314-2718 | 2018-11-27 |
| 1467945444 | Lynette Singleton Brown | Specialist | 1509 Virginia Ave, Atlanta, GA 30337-2841 | 2018-06-13 |
| 1952806572 | Prerana Upadhyaya | Specialist | 920 Dannon Vw Sw Ste 3103, Atlanta, GA 30331-2158 | 2018-03-26 |
| 1225566300 | Aspire Fertility Georgia, LLC | Specialist | 6 Concourse Pkwy Ste 250, Atlanta, GA 30328-6117 | 2017-06-01 |
| 1376086256 | Integrated Healthcare Center of Dunwoody LLC | Specialist | 6115 Peachtree Dunwoody Rd, Atlanta, GA 30328-5546 | 2016-11-28 |
| 1063960748 | Lynda Louise Parrish | Specialist | 842 N Highland Ave Ne Ste 223, Atlanta, GA 30306-4530 | 2016-09-12 |
| 1922551118 | Shelley Fondren | Specialist | 5817 Jamerson Dr, Atlanta, GA 30349-7018 | 2016-07-25 |
| Find all providers in ATLANTA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.