Provider Demographics
NPI:1093469355
Name:SOUTHERN PAIN AND SPINE ASSOCIATES LLC
Entity Type:Organization
Organization Name:SOUTHERN PAIN AND SPINE ASSOCIATES LLC
Other - Org Name:SOUTHERN PAIN AND SPINE - JASPER
Other - Org Type:Other Name
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:470-628-9203
Mailing Address - Street 1:PO BOX 28415
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-2036
Mailing Address - Country:US
Mailing Address - Phone:888-488-8289
Mailing Address - Fax:502-919-9780
Practice Address - Street 1:1101 OLD PHILADELPHIA RD STE G100
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-4044
Practice Address - Country:US
Practice Address - Phone:678-971-4167
Practice Address - Fax:833-989-2501
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHERN PAIN AND SPINE ASSOCIATES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-02-07
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA72139OtherGCMB