Healthcare Provider Details

I. General information

NPI: 1104473693
Provider Name (Legal Business Name): CONSULTANTS IN PAIN MANAGEMENT, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2019
Last Update Date: 08/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1726 GUNBARREL RD
CHATTANOOGA TN
37421-4752
US

IV. Provider business mailing address

PO BOX 63236
CHARLOTTE NC
28263-3001
US

V. Phone/Fax

Practice location:
  • Phone: 423-648-8480
  • Fax: 423-648-8481
Mailing address:
  • Phone: 423-648-8480
  • Fax: 423-648-8481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: GREGORY N BALL
Title or Position: PRESIDENT
Credential: MD
Phone: 423-648-8480