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General NPI Number Information
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NPI Number | 1669828315
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Entity Type | Organization
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Legal Business Name | PORTLAND WELLNESS CENTER PLLC
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Dates
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Enumeration Date | 05/12/2016
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Last Update Date | 05/12/2016
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Provider Practice Location Address
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Address Line | 105 E MARKET ST
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City | PORTLAND
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State | TN
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Zip | 37148-1228
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Country | US
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Telephone | 615-325-5000
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Fax | 615-323-8400
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Provider Business Mailing Address
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Address Line | 105 E MARKET ST
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City | PORTLAND
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State | TN
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Zip | 37148-1228
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Country | US
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Telephone | 615-325-5000
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Fax | 615-323-8400
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Authorized Official
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Title or Position | OWNER
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Name | DR. VERNA BAIN
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Credential | M.D
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Telephone | 615-445-9133
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD0000031162
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License Number State | TN
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