Organization
SOUTHEASTERN INTERVENTIONAL PAIN ASC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANKUR PATEL DO (OWNER)
(678) 971-4167
Entity
Organization
Contact information
Practice address
1150 HAMMOND DR NE, LL 50, ATLANTA, GA 30328
(678) 971-4167
(678) 971-4168
Mailing address
PO BOX 37580, BELFAST, ME 04915-1217
(678) 971-4167
(833) 989-2501
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
LNR-ASC2014-023
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
202G498226
MEDICARE
GA
Enumeration date
01/12/2010
Last updated
02/20/2026
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