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General NPI Number Information
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NPI Number | 1346562048
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Entity Type | Organization
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Legal Business Name | PAIN MANAGEMENT GROUP, P.C.
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Dates
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Enumeration Date | 02/22/2010
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Last Update Date | 03/14/2013
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Provider Practice Location Address
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Address Line | 40 W CALDWELL ST SUITE 200
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City | MOUNT JULIET
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State | TN
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Zip | 37122-2910
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Country | US
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Telephone | 615-553-5640
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Fax | 615-553-5644
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Provider Business Mailing Address
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Address Line | 5801 CROSSINGS BLVD
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City | ANTIOCH
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State | TN
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Zip | 37013-3130
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Country | US
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Telephone | 615-941-8501
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Fax | 615-941-8102
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DEREK OLIVER
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Credential |
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Telephone | 615-941-8501
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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 |
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License Number State |
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