Healthcare Provider Details

I. General information

NPI: 1700350287
Provider Name (Legal Business Name): SOUTHERN PAIN & SPINE SPECIALISTS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2019
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3081 SENNA DR
MATTHEWS NC
28105-6727
US

IV. Provider business mailing address

3081 SENNA DR
MATTHEWS NC
28105-6727
US

V. Phone/Fax

Practice location:
  • Phone: 833-704-7246
  • Fax:
Mailing address:
  • Phone: 833-704-7246
  • Fax: 704-512-0507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: AMMAR A ALAMARIE
Title or Position: OWNER
Credential: MD
Phone: 833-704-7246