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General NPI Number Information
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NPI Number | 1649523689
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Entity Type | Organization
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Legal Business Name | SOUTHEAST SPINE & PAIN ASSOCIATES LLC
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Dates
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Enumeration Date | 10/15/2012
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Last Update Date | 03/12/2015
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Provider Practice Location Address
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Address Line | 1718 SAINT MARY ST
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City | KNOXVILLE
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State | TN
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Zip | 37917-4517
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Country | US
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Telephone | 865-633-9469
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Fax | 865-633-9474
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Provider Business Mailing Address
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Address Line | PO BOX 27629
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City | KNOXVILLE
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State | TN
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Zip | 37927-7629
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Country | US
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Telephone | 865-633-9469
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Fax | 865-633-9474
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Authorized Official
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Title or Position | CREDENTIALING/BILLING MANAGER
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Name | CHRISTIE LORD
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Credential |
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Telephone | 865-633-9469
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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