Provider Demographics
NPI:1659855252
Name:SOUTHERN PAIN AND REGENERATIVE MEDICINE PC
Entity type:Organization
Organization Name:SOUTHERN PAIN AND REGENERATIVE MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:D
Authorized Official - Last Name:HODGKISS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-350-0678
Mailing Address - Street 1:1720 E REELFOOT AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:TN
Mailing Address - Zip Code:38261-6049
Mailing Address - Country:US
Mailing Address - Phone:901-350-0678
Mailing Address - Fax:901-350-0677
Practice Address - Street 1:1720 E REELFOOT AVE STE 200
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-6049
Practice Address - Country:US
Practice Address - Phone:901-350-0678
Practice Address - Fax:901-350-0677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty