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General NPI Number Information
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NPI Number | 1306496567
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Entity Type | Organization
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Legal Business Name | PAIN CLINIC ASSOCIATES PLLC
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Dates
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Enumeration Date | 09/18/2019
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Last Update Date | 03/15/2024
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Provider Practice Location Address
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Address Line | 7600 AIRWAYS BLVD STE A
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City | SOUTHAVEN
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State | MS
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Zip | 38671-5138
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Country | US
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Telephone | 901-747-0040
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Fax | 901-747-0038
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Provider Business Mailing Address
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Address Line | PO BOX 931320
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City | ATLANTA
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State | GA
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Zip | 31193-1320
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | RAY SAUNDERS
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Credential |
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Telephone | 901-507-1595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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