Organization
SOUTHERN PAIN INSTITUTE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTHONY T CLAVO SR. MD (CEO)
(770) 632-3730
Entity
Organization
Contact information
Practice address
1501 MILSTEAD RD NE, SUITE 140, CONYERS, GA 30012-3838
(770) 632-3730
(770) 632-3731
Mailing address
1975 HIGHWAY 54 W, SUITE 100, PEACHTREE CITY, GA 30269-4794
(770) 632-3730
(770) 632-3731
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
045425
GA
Other
Enumeration date
01/31/2007
Last updated
07/30/2015
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