Healthcare Provider Details

I. General information

NPI: 1134596760
Provider Name (Legal Business Name): PAIN PARTNERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2015
Last Update Date: 08/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 14TH ST
MERIDIAN MS
39301-4458
US

IV. Provider business mailing address

1001 14TH ST
MERIDIAN MS
39301-4458
US

V. Phone/Fax

Practice location:
  • Phone: 601-482-9224
  • Fax: 601-482-9223
Mailing address:
  • Phone: 601-482-9224
  • Fax: 601-482-9223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number13082
License Number StateMS

VIII. Authorized Official

Name: MR. JOEY DAUGHERTY
Title or Position: ADMINISTRATOR
Credential: RN, BSN
Phone: 601-482-9224