Provider Demographics
NPI:1356630792
Name:PHENIX CITY PAIN MANAGEMENT
Entity Type:Organization
Organization Name:PHENIX CITY PAIN MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BILL
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:BERRYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-214-4616
Mailing Address - Street 1:1810 STADIUM DR
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36867-3177
Mailing Address - Country:US
Mailing Address - Phone:334-664-1969
Mailing Address - Fax:888-391-2191
Practice Address - Street 1:1810 STADIUM DR STE 140
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36867-3178
Practice Address - Country:US
Practice Address - Phone:334-214-4616
Practice Address - Fax:334-214-4618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-06
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL26975208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty