NPI 1063971596

Southern Interventional Pain Center LLC

Organisation Interventional Pain Medicine Physician Lake City, FL

Practice location

Address: 619 SW Baya Dr STE 102, Lake City, FL 32025-4204
Phone: (386) 361-3400
Fax: (855) 313-1262
Mailing address: 615 S Hansell St, Thomasville, GA 31792-5556

Authorised official

Name: Maximilian Shahryar Shokat
Title: Managing Member
Phone: (229) 226-2234

Registered specialties (2)

Interventional Pain Medicine Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 208VP0014X

Other Pain Medicine providers in Florida →

Neurology Physician

Allopathic & Osteopathic Physicians Taxonomy 2084N0400X

Other Psychiatry & Neurology providers in Florida →

Registry record

NPI: 1063971596
Entity type: Organization
NPI issued: 14 Mar 2019
Record last updated: 31 Jan 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.