Provider Demographics
NPI:1023522380
Name:PHIAKHAMTA, JOE (LAC)
Entity type:Individual
Prefix:
First Name:JOE
Middle Name:
Last Name:PHIAKHAMTA
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 CENTERVIEW DR UNIT 240
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5480
Mailing Address - Country:US
Mailing Address - Phone:615-669-5953
Mailing Address - Fax:
Practice Address - Street 1:125 BELLE FOREST CIR STE 100
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37221-2126
Practice Address - Country:US
Practice Address - Phone:615-669-3331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-24
Last Update Date:2017-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN310171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist