Provider Demographics
NPI:1346315710
Name:MID-SOUTH PAIN MANAGEMENT, PC
Entity Type:Organization
Organization Name:MID-SOUTH PAIN MANAGEMENT, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-503-9000
Mailing Address - Street 1:PO BOX 1226
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37065-1226
Mailing Address - Country:US
Mailing Address - Phone:615-503-9000
Mailing Address - Fax:615-435-0549
Practice Address - Street 1:2020 COWAN HWY STE 2
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37398-2446
Practice Address - Country:US
Practice Address - Phone:931-962-1220
Practice Address - Fax:931-962-2520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208VP0000X
TN44D2054802291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1346315710Medicaid
TN3736076Medicaid
NC2335613Medicare PIN
TN3736076Medicaid
TN3736076Medicare PIN