Provider Demographics
NPI:1992124127
Name:SPINAL PAIN SOLUTIONS PLLC
Entity type:Organization
Organization Name:SPINAL PAIN SOLUTIONS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER / NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SOUTH
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:865-963-1729
Mailing Address - Street 1:PO BOX 1081
Mailing Address - Street 2:
Mailing Address - City:HARRIMAN
Mailing Address - State:TN
Mailing Address - Zip Code:37748-1081
Mailing Address - Country:US
Mailing Address - Phone:865-285-9284
Mailing Address - Fax:865-882-3664
Practice Address - Street 1:1208 S ROANE ST
Practice Address - Street 2:
Practice Address - City:HARRIMAN
Practice Address - State:TN
Practice Address - Zip Code:37748-7420
Practice Address - Country:US
Practice Address - Phone:865-285-9284
Practice Address - Fax:865-882-3664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain