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General NPI Number Information
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NPI Number | 1134596760
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Entity Type | Organization
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Legal Business Name | PAIN PARTNERS, LLC
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Dates
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Enumeration Date | 08/31/2015
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Last Update Date | 08/31/2015
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Provider Practice Location Address
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Address Line | 1001 14TH ST
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City | MERIDIAN
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State | MS
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Zip | 39301-4458
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Country | US
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Telephone | 601-482-9224
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Fax | 601-482-9223
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Provider Business Mailing Address
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Address Line | 1001 14TH ST
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City | MERIDIAN
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State | MS
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Zip | 39301-4458
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Country | US
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Telephone | 601-482-9224
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Fax | 601-482-9223
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. JOEY DAUGHERTY
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Credential | RN, BSN
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Telephone | 601-482-9224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 13082
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License Number State | MS
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