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General NPI Number Information
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NPI Number | 1104145689
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Entity Type | Organization
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Legal Business Name | ADVANCED PAIN CLINIC, P.C.
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Dates
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Enumeration Date | 05/24/2010
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Last Update Date | 05/21/2020
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Provider Practice Location Address
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Address Line | 1345 W MAIN ST
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City | FRANKLIN
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State | TN
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Zip | 37064-3703
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Country | US
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Telephone | 615-794-5009
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Fax | 615-790-7531
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Provider Business Mailing Address
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Address Line | PO BOX 190
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City | FRANKLIN
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State | TN
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Zip | 37065-0190
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Country | US
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Telephone | 615-794-5009
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Fax | 615-790-7531
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | GIOVANNI FACCIA
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Credential | M.D.
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Telephone | 615-794-5009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD12669
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License Number State | TN
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