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General NPI Number Information
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NPI Number | 1285976407
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Entity Type | Organization
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Legal Business Name | INTERVENTIONAL PAIN CENTER, PLLC
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Dates
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Enumeration Date | 03/26/2013
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Last Update Date | 10/17/2023
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Provider Practice Location Address
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Address Line | 353 NEW SHACKLE ISLAND RD STE 148C
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City | HENDERSONVILLE
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State | TN
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Zip | 37075-2366
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Country | US
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Telephone | 615-972-1000
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Fax | 615-537-4950
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Provider Business Mailing Address
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Address Line | 353 NEW SHACKLE ISLAND RD SUITE 101-A
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City | HENDERSONVILLE
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State | TN
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Zip | 37075-2379
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Country | US
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Telephone | 615-972-1100
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Fax | 615-537-4950
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRAD PAUL WILSON
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Credential | DO
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Telephone | 615-972-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | DO0000002339
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License Number State | TN
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