Organization
SOUTHERN PAIN AND SPINE ASSOCIATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPHINE EVANGELISTA (CREDENTIALING MANAGER)
(404) 408-2144
Entity
Organization
Contact information
Practice address
1150 HAMMOND DR STE 50, ATLANTA, GA 30328-7500
(678) 971-4167
(833) 989-2501
Mailing address
1233 HIGHWAY 54 W STE 207, FAYETTEVILLE, GA 30214-4643
(678) 971-4167
(833) 989-2501
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
05/02/2025
Last updated
01/05/2026
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