Provider Demographics
NPI:1508648445
Name:SOUTHERN INJURY SPECIALISTS LLC
Entity Type:Organization
Organization Name:SOUTHERN INJURY SPECIALISTS LLC
Other - Org Name:SOUTHERN INJURY SPECIALISTS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANKUR
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:205-422-5189
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 1:601 BROAD ST SE STE A
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3718
Practice Address - Country:US
Practice Address - Phone:678-971-4167
Practice Address - Fax:833-989-2501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-16
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty