Healthcare Provider Details

I. General information

NPI: 1922230986
Provider Name (Legal Business Name): SOUTHERN PAIN INSTITUTE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2009
Last Update Date: 08/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5073 MAIN ST SUITE 100
SPRING HILL TN
37174-2737
US

IV. Provider business mailing address

PO BOX 50053
NASHVILLE TN
37205-0053
US

V. Phone/Fax

Practice location:
  • Phone: 615-459-3244
  • Fax: 615-459-6525
Mailing address:
  • Phone: 615-459-3244
  • Fax: 615-459-6525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number34231
License Number StateTN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ANNA-LOUISE O MOLETTE
Title or Position: OWNER
Credential: M.D.
Phone: 615-459-3244