Healthcare Provider Details

I. General information

NPI: 1700742616
Provider Name (Legal Business Name): SOUTHERN PAIN AND SPINE ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 OLD PHILADELPHIA RD STE G100
JASPER GA
30143-4044
US

IV. Provider business mailing address

1101 OLD PHILADELPHIA RD STE G100
JASPER GA
30143-4044
US

V. Phone/Fax

Practice location:
  • Phone: 678-971-4167
  • Fax: 833-989-2501
Mailing address:
  • Phone: 678-971-4167
  • Fax: 833-989-2501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: ANKUR BHARAT PATEL
Title or Position: CEO / MANAGING PARTNER
Credential: MD
Phone: 678-971-4167