Provider Demographics
NPI:1538367529
Name:SOUTHERN PAIN INSTITUTE PLLC
Entity type:Organization
Organization Name:SOUTHERN PAIN INSTITUTE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA-LOUISE
Authorized Official - Middle Name:O
Authorized Official - Last Name:MOLETTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-459-3244
Mailing Address - Street 1:PO BOX 50053
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-0053
Mailing Address - Country:US
Mailing Address - Phone:615-459-3244
Mailing Address - Fax:615-459-6525
Practice Address - Street 1:739 PRESIDENT PL
Practice Address - Street 2:SUITE 220
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-6844
Practice Address - Country:US
Practice Address - Phone:615-459-3244
Practice Address - Fax:615-459-6525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN342312081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty