Provider Demographics
NPI:1801047493
Name:SMYRNA PAIN CONSULTANTS, P.C.
Entity type:Organization
Organization Name:SMYRNA PAIN CONSULTANTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEATHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:615-459-0100
Mailing Address - Street 1:1450 SAM DAVIS RD STE 170
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-2737
Mailing Address - Country:US
Mailing Address - Phone:615-459-0100
Mailing Address - Fax:615-355-4212
Practice Address - Street 1:1450 SAM DAVIS RD STE 170
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-2737
Practice Address - Country:US
Practice Address - Phone:615-459-0100
Practice Address - Fax:615-355-4212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-01
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6171230001Medicare NSC