Healthcare Provider Details

I. General information

NPI: 1427340603
Provider Name (Legal Business Name): NORTHERN TENNESSEE PAIN MANAGEMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2011
Last Update Date: 07/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 8TH AVE S
NASHVILLE TN
37203-5011
US

IV. Provider business mailing address

7986 TANNERS GATE LN
FLORENCE KY
41042-1863
US

V. Phone/Fax

Practice location:
  • Phone: 859-746-2444
  • Fax: 859-746-9666
Mailing address:
  • Phone: 859-746-2444
  • Fax: 859-746-9666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BRAD HAMBLEN
Title or Position: MEMBER
Credential:
Phone: 859-746-2444