Healthcare Provider Details

I. General information

NPI: 1982146361
Provider Name (Legal Business Name): PAIN MANAGEMENT OF MIDDLE TENNESSEE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2016
Last Update Date: 02/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 23RD AVE N SUITE 130
NASHVILLE TN
37203-1534
US

IV. Provider business mailing address

110 29TH AVE N SUITE 202
NASHVILLE TN
37203-1401
US

V. Phone/Fax

Practice location:
  • Phone: 615-620-1650
  • Fax: 615-620-1654
Mailing address:
  • Phone: 615-327-4340
  • Fax: 615-327-7940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PATRICK A FORREST
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 615-327-4304