Organization
SOUTHERN PAIN INSTITUTE, PC
Active
Other names
Southern Spine & Pain Institute
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANTHONY THADDEUS CLAVO SR. M.D. (PRESIDENT/OWNER)
(770) 632-3730
Entity
Organization
Contact information
Practice address
3886 PRINCETON LAKES WAY SW, STE 240, ATLANTA, GA 30331-5511
(770) 632-3730
(770) 632-3731
Mailing address
PO BOX 740209, LOCKBOX DEPT 40257, ATLANTA, GA 30374-0209
(770) 632-3730
(770) 632-3731
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
045425
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
208VP0014X
PAIN MEDICINE-INTERVENTIONAL PAIN MEDICINE TAXONOMY
GA
01
—
GRP6066
MEDICARE ID
GA
Enumeration date
06/20/2014
Last updated
06/20/2014
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