Basic Information
Provider Information
NPI: 1538367529
EntityType: 2
ReplacementNPI:  
OrganizationName: SOUTHERN PAIN INSTITUTE PLLC
LastName:  
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Mailing Information
Address1: PO BOX 50053
Address2:  
City: NASHVILLE
State: TN
PostalCode: 372050053
CountryCode: US
TelephoneNumber: 6154593244
FaxNumber: 6154596525
Practice Location
Address1: 739 PRESIDENT PL
Address2: SUITE 220
City: SMYRNA
State: TN
PostalCode: 371676844
CountryCode: US
TelephoneNumber: 6154593244
FaxNumber: 6154596525
Other Information
ProviderEnumerationDate: 07/11/2007
LastUpdateDate: 09/28/2007
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: MOLETTE
AuthorizedOfficialFirstName: ANNA-LOUISE
AuthorizedOfficialMiddleName: O
AuthorizedOfficialTitleorPosition: OWNER
AuthorizedOfficialTelephone: 6154593244
IsSoleProprietor:  
IsOrganizationSubpart: N
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AuthorizedOfficialCredential: MD
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2081P2900X34231TNY193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine

No ID Information.


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