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NPI Code Detail

MEDICARE: SOUTHEASTERN PAIN AND WELLNESS, PLLC

MEDICARE: SOUTHEASTERN PAIN AND WELLNESS, PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208VP0014XInterventional Pain Medicine Physician

General Provider Information

NPI Number : 1992310502
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHEASTERN PAIN AND WELLNESS, PLLC
Provider Business Mailing Address
First Line : 7956 VAUGHN RD # 165
Second Line :
City : MONTGOMERY
State : AL
Zip : 36116-6625
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 402 W KING ST
Second Line :
City : KING
State : NC
Zip : 27021-9170
Country : US
Telephone Number : 336-391-0801
Fax Number : 877-781-0070
Authorized Official
Title or Position : AO
Name : DAVID TUNNELL
Credential :
Telephone Number : 252-412-4465
Provider Enumeration Date : 09/10/2020
Last Update Date : 02/03/2021

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Directions to “SOUTHEASTERN PAIN AND WELLNESS, PLLC ” Practice Location

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