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General NPI Number Information
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NPI Number | 1558546994
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Entity Type | Organization
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Legal Business Name | SOUTHSIDE PAIN SPECIALISTS, PC
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Dates
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Enumeration Date | 01/04/2008
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Last Update Date | 01/13/2022
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Provider Practice Location Address
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Address Line | 1020 26TH ST S SUITE 100
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City | BIRMINGHAM
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State | AL
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Zip | 35205-2412
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Country | US
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Telephone | 205-332-3155
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Fax | 205-332-3162
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Provider Business Mailing Address
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Address Line | 1020 26TH ST S
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City | BIRMINGHAM
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State | AL
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Zip | 35205-2412
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Country | US
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Telephone | 205-332-3155
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Fax | 205-332-3162
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JIM CARSON
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Credential |
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Telephone | 205-202-5711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 19356
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License Number State | AL
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