Healthcare Provider Details

I. General information

NPI: 1568700391
Provider Name (Legal Business Name): GENESIS ANALGESIA CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2013
Last Update Date: 07/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 CURRIER LN
KNOXVILLE TN
37919-8821
US

IV. Provider business mailing address

1408 CURRIER LN
KNOXVILLE TN
37919-8821
US

V. Phone/Fax

Practice location:
  • Phone: 865-607-3851
  • Fax:
Mailing address:
  • Phone: 865-692-4141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD20094
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberMD20094
License Number StateTN

VIII. Authorized Official

Name: DR. DAVID NEWMAN
Title or Position: ORGANIZING MEMBER
Credential: M.D.
Phone: 252-414-7395