Provider Demographics
NPI:1104976695
Name:SOUTHERN PAIN CONTROL CENTER, INC.
Entity type:Organization
Organization Name:SOUTHERN PAIN CONTROL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MEDHA
Authorized Official - Middle Name:A
Authorized Official - Last Name:PRADHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-395-6055
Mailing Address - Street 1:7205 COPPERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-7101
Mailing Address - Country:US
Mailing Address - Phone:334-396-6055
Mailing Address - Fax:334-273-0952
Practice Address - Street 1:7205 COPPERFIELD DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-7101
Practice Address - Country:US
Practice Address - Phone:334-396-6055
Practice Address - Fax:334-273-0952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21981208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty