# SOUTHERN PAIN INSTITUTE P C

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Parish Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1750665584
- **Authorized official:** LYNN CLAVO (CHIEF PHARMACIST)
- **Authorized official phone:** (770) 313-3380

## Contact information

- **Practice address:** 1975 HIGHWAY 54 W STE 100, FAYETTEVILLE, GA 30214-4794
- **Practice address phone:** (770) 631-5158
- **Practice address fax:** (770) 632-3731
- **Mailing address:** 1975 HIGHWAY 54 W, SUITE 100, FAYETTEVILLE, GA 30214-4794
- **Mailing address phone:** (770) 631-5158
- **Mailing address fax:** (404) 591-7959

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | PHRE009784 | GA | Yes |
| 3336C0004X | Compounding Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 09/28/2011
- **Last updated:** 03/20/2013