Provider Demographics
NPI:1093709958
Name:SOUTHERN PAIN ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:SOUTHERN PAIN ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-482-9224
Mailing Address - Street 1:PO BOX 649105
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75264
Mailing Address - Country:US
Mailing Address - Phone:903-571-3844
Mailing Address - Fax:855-343-5763
Practice Address - Street 1:1001 14TH ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4458
Practice Address - Country:US
Practice Address - Phone:601-482-9224
Practice Address - Fax:601-482-9223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS002325011Medicaid
MSDC1629OtherMEDICARE RAILROAD
MSC03134Medicare ID - Type Unspecified