| Southern Interventional Pain Center Llc | |
|
615 S Hansell St Thomasville GA 31792-5556 | |
| (229) 226-2234 | |
| Not Available |
| Full Name | Southern Interventional Pain Center Llc |
|---|---|
| Speciality | Pain Medicine |
| Location | 615 S Hansell St, Thomasville, Georgia |
| Authorized Official Name and Position | Maximilian Shokat (MEDICAL DIRECTOR) |
| Authorized Official Contact | 2292262234 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Interventional Pain Center Llc 615 S Hansell St Thomasville GA 31792-5556 Ph: (229) 226-2234 | Southern Interventional Pain Center Llc 615 S Hansell St Thomasville GA 31792-5556 Ph: (229) 226-2234 |
| NPI Number | 1306225479 |
|---|---|
| Provider Enumeration Date | 05/22/2015 |
| Last Update Date | 01/31/2020 |
| Certification Date | 01/31/2020 |
| Medicare PECOS PAC ID | 9436460318 |
|---|---|
| Medicare Enrollment ID | O20150618001544 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306225479 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Secondary |
| 208VP0014X | Pain Medicine - Interventional Pain Medicine | (* (Not Available)) | Primary |
| Provider Name | Maximilian S Shokat |
|---|---|
| Provider Type | Practitioner - Pain Management |
| Provider Identifiers | NPI Number: 1659559789 PECOS PAC ID: 7113066093 Enrollment ID: I20091207000192 |
| Provider Name | Jonathan D Tarin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790312387 PECOS PAC ID: 1355718776 Enrollment ID: I20221027001834 |
| Provider Name | Roger Jerome Pierce |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578347761 PECOS PAC ID: 7214376136 Enrollment ID: I20240411002790 |
Graves Psychological Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 319 N Stevens St, Thomasville, GA 31792 Phone: 229-221-3442 Fax: 855-560-7664 | |
Georgia Pines Community Service Board Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 367 Shoreline Dr, Apt A&b, Thomasville, GA 31757 Phone: 229-225-4335 Fax: 229-225-4374 | |
Georgia Pines Community Service Board Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 14244 Us Highway 19 S, Thomasville, GA 31757 Phone: 229-225-4335 Fax: 229-225-4374 | |
Georgia Pines Community Service Board Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 407 Cloverdale Drive, Thomasville, GA 31792 Phone: 229-233-8904 | |
Crossing Jordan Counseling Services, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 125 N Broad St Ste 302, Thomasville, GA 31792 Phone: 912-212-5803 Fax: 229-512-3767 | |
Georgia Pines Community Service Board Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1102 Smith Ave, Thomasville, GA 31792 Phone: 229-225-4335 Fax: 229-225-4374 |