Provider Demographics
NPI:1538804513
Name:SOUTHERN PAIN AND SPINE ASSOCIATES, LLC
Entity type:Organization
Organization Name:SOUTHERN PAIN AND SPINE ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:HAMISH
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-971-4167
Mailing Address - Street 1:601 BROAD ST SE STE A
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3718
Mailing Address - Country:US
Mailing Address - Phone:678-971-4167
Mailing Address - Fax:
Practice Address - Street 1:1500 OGLETHORPE AVE STE 500A
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2184
Practice Address - Country:US
Practice Address - Phone:678-971-4167
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty