Healthcare Provider Details

I. General information

NPI: 1417817347
Provider Name (Legal Business Name): PAIN MEDICINE OF THE SOUTH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2025
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 KELSEY LN STE 104
LENOIR CITY TN
37772-6442
US

IV. Provider business mailing address

149 KELSEY LN STE 104
LENOIR CITY TN
37772-6442
US

V. Phone/Fax

Practice location:
  • Phone: 865-672-5070
  • Fax: 865-671-6680
Mailing address:
  • Phone: 865-672-5070
  • Fax: 865-671-6680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARK RYAN JONES
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 865-672-5070