Provider Demographics
NPI:1174697106
Name:SOUTHERN PAIN SPECIALISTS, P.C.
Entity type:Organization
Organization Name:SOUTHERN PAIN SPECIALISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:G
Authorized Official - Last Name:VARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-995-9967
Mailing Address - Street 1:7191 CAHABA VALLEY RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-6402
Mailing Address - Country:US
Mailing Address - Phone:205-995-9967
Mailing Address - Fax:205-995-0635
Practice Address - Street 1:7191 CAHABA VALLEY RD
Practice Address - Street 2:SUITE 204
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-6402
Practice Address - Country:US
Practice Address - Phone:205-995-9967
Practice Address - Fax:205-995-0635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL491103TC0700X
AL19582208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALB92369Medicare UPIN