Healthcare Provider Details

I. General information

NPI: 1336640507
Provider Name (Legal Business Name): ELITE PAIN CONSULTANTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2018
Last Update Date: 07/06/2022
Certification Date: 07/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11416 GRIGSBY CHAPEL RD STE 104
KNOXVILLE TN
37934-1649
US

IV. Provider business mailing address

PO BOX 2070
CLEVELAND TN
37320-2070
US

V. Phone/Fax

Practice location:
  • Phone: 865-218-2100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CASSY ELLEDGE
Title or Position: REVENUE DIRECTOR
Credential:
Phone: 423-476-5774