Healthcare Provider Details

I. General information

NPI: 1346315710
Provider Name (Legal Business Name): MID-SOUTH PAIN MANAGEMENT, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 03/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 COWAN HWY STE 2
WINCHESTER TN
37398-2446
US

IV. Provider business mailing address

PO BOX 1226
FRANKLIN TN
37065-1226
US

V. Phone/Fax

Practice location:
  • Phone: 931-962-1220
  • Fax: 931-962-2520
Mailing address:
  • Phone: 615-503-9000
  • Fax: 615-435-0549

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 Code291U00000X
TaxonomyClinical Medical Laboratory
License Number44D2054802
License Number StateTN

VIII. Authorized Official

Name: LISABETH A WILLIAMS
Title or Position: OWNER
Credential: M.D.
Phone: 615-503-9000