# SOUTHERN PAIN INSTITUTE P C

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Southern Pain Institute
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174836845
- **Authorized official:** LYNN CLAVO (PIC)
- **Authorized official phone:** (770) 632-3730

## Contact information

- **Practice address:** 1501 MILSTEAD RD NE STE 140, CONYERS, GA 30012-3849
- **Practice address phone:** (770) 632-3730
- **Practice address fax:** (770) 632-3731
- **Mailing address:** 1975 HIGHWAY 54 W, STE 100, PEACHTREE CITY, GA 30269-4794
- **Mailing address phone:** (770) 313-3380
- **Mailing address fax:** (770) 632-3731

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | PHRE009658 | GA | Yes |

## Other

- **Enumeration date:** 07/22/2010
- **Last updated:** 02/24/2015