# PAIN SPINE & WELLNESS LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Dedicated Pain & Wellness
- **Organization subpart:** No

## Provider details

- **NPI number:** 1942868377
- **Authorized official:** SOURIAL MORRIS SOURIAL DO (PRESIDENT)
- **Authorized official phone:** (904) 944-2124

## Contact information

- **Practice address:** 9770 OLD BAYMEADOWS RD STE 141, JACKSONVILLE, FL 32256-7986
- **Practice address phone:** (904) 944-2124
- **Practice address fax:** (888) 241-3383
- **Mailing address:** 10689 TOWN VIEW DR, JACKSONVILLE, FL 32256-4026
- **Mailing address phone:** (904) 944-2124
- **Mailing address fax:** (888) 241-3383

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QA0505X | Adult Medicine Physician | — | NULL | Yes |
| 207QA0505X | Adult Medicine Physician | — | — | Yes |
| 208VP0000X | Pain Medicine Physician | — | NULL | — |
| 208VP0000X | Pain Medicine Physician | — | — | — |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 05/31/2019
- **Last updated:** 11/11/2024