Basic Information
| Provider Information | |||||||||
| NPI: | 1427479328 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TENNESSEE PAIN MANAGEMENT ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 655 | ||||||||
| Address2: | |||||||||
| City: | WAYNESBORO | ||||||||
| State: | TN | ||||||||
| PostalCode: | 384850655 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9317226690 | ||||||||
| FaxNumber: | 9317226691 | ||||||||
| Practice Location | |||||||||
| Address1: | 530 US HWY 64 | ||||||||
| Address2: | SUITE 5 | ||||||||
| City: | WAYNESBORO | ||||||||
| State: | TN | ||||||||
| PostalCode: | 38485 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9313324131 | ||||||||
| FaxNumber: | 9317229627 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2013 | ||||||||
| LastUpdateDate: | 04/03/2014 | ||||||||
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| AuthorizedOfficialLastName: | HALL | ||||||||
| AuthorizedOfficialFirstName: | JOE | ||||||||
| AuthorizedOfficialMiddleName: | I | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9317224242 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
No ID Information.