Provider Demographics
NPI:1104145689
Name:ADVANCED PAIN CLINIC, P.C.
Entity type:Organization
Organization Name:ADVANCED PAIN CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GIOVANNI
Authorized Official - Middle Name:
Authorized Official - Last Name:FACCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-794-5009
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37065-0190
Mailing Address - Country:US
Mailing Address - Phone:615-794-5009
Mailing Address - Fax:615-790-7531
Practice Address - Street 1:1345 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-3703
Practice Address - Country:US
Practice Address - Phone:615-794-5009
Practice Address - Fax:615-790-7531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-24
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD12669174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN$$$$$$$$$OtherSOCIAL SECURITY NUMBER