Healthcare Provider Details

I. General information

NPI: 1447578018
Provider Name (Legal Business Name): TENNESSEE RIVER PAIN MANAGEMENT CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2010
Last Update Date: 08/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275A EUREKA ST
SAVANNAH TN
38372-3033
US

IV. Provider business mailing address

275A EUREKA ST
SAVANNAH TN
38372-3033
US

V. Phone/Fax

Practice location:
  • Phone: 731-925-7246
  • Fax: 731-925-7991
Mailing address:
  • Phone: 731-925-7246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number13057
License Number StateTN

VIII. Authorized Official

Name: MS. TERESA DIANE DAILEY
Title or Position: NP
Credential: NP, MSN
Phone: 731-925-7246