Healthcare Provider Details

I. General information

NPI: 1922304500
Provider Name (Legal Business Name): VONORE PAIN MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2011
Last Update Date: 01/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 HIGHWAY 411 SUITE 6
VONORE TN
37885-2457
US

IV. Provider business mailing address

1255 HIGHWAY 411 SUITE 6
VONORE TN
37885-2457
US

V. Phone/Fax

Practice location:
  • Phone: 423-884-3400
  • Fax: 423-884-3401
Mailing address:
  • Phone: 423-884-3400
  • Fax: 423-884-3401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RETHA E ALEXANDER
Title or Position: OWNER/PRACTITIONER
Credential: APN
Phone: 865-884-3400