Healthcare Provider Details

I. General information

NPI: 1518244367
Provider Name (Legal Business Name): SOUTHERN PAIN MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2011
Last Update Date: 11/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2339 MCCALLIE AVE SUITE 309
CHATTANOOGA TN
37404-3256
US

IV. Provider business mailing address

705 COOK DR SUITE 203
ATHENS TN
37303-3494
US

V. Phone/Fax

Practice location:
  • Phone: 423-698-0850
  • Fax: 423-698-0511
Mailing address:
  • Phone: 423-744-1300
  • Fax: 423-744-1305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: THOMAS P MILLER
Title or Position: PRESIDENT
Credential: MD
Phone: 423-698-0850