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General NPI Number Information
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NPI Number | 1336744770
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Entity Type | Organization
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Legal Business Name | SOUTHERN PAIN AND SPINE ASSOCIATES LLC
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Dates
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Enumeration Date | 12/03/2020
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Last Update Date | 07/07/2025
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Provider Practice Location Address
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Address Line | 601 BROAD ST SE STE B
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City | GAINESVILLE
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State | GA
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Zip | 30501-3718
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Country | US
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Telephone | 678-971-4167
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Fax | 833-989-2501
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Provider Business Mailing Address
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Address Line | 1233 HIGHWAY 54 W STE 200
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-4542
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Country | US
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Telephone | 678-971-4167
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Fax | 883-428-2629
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Authorized Official
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Title or Position | CEO/ OWNER PARTNER
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Name | ANKUR BHARAT PATEL
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Credential | MD
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Telephone | 678-971-4167
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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