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General NPI Number Information
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NPI Number | 1518244367
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Entity Type | Organization
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Legal Business Name | SOUTHERN PAIN MANAGEMENT
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Dates
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Enumeration Date | 11/08/2011
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Last Update Date | 11/08/2011
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Provider Practice Location Address
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Address Line | 2339 MCCALLIE AVE SUITE 309
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City | CHATTANOOGA
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State | TN
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Zip | 37404-3256
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Country | US
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Telephone | 423-698-0850
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Fax | 423-698-0511
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Provider Business Mailing Address
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Address Line | 705 COOK DR SUITE 203
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City | ATHENS
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State | TN
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Zip | 37303-3494
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Country | US
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Telephone | 423-744-1300
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Fax | 423-744-1305
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Authorized Official
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Title or Position | PRESIDENT
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Name | THOMAS P MILLER
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Credential | MD
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Telephone | 423-698-0850
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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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