# SOUTHEAST TENNESSEE SPINE AND NERVE INSTITUTE PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1902225972
- **Authorized official:** JOHN WALL (CLINICDIRECTOR)
- **Authorized official phone:** (423) 296-2604

## Contact information

- **Practice address:** 1334 MACKEY BRANCH DR, SUITE 104, CHATTANOOGA, TN 37421-3471
- **Practice address phone:** (423) 296-2604
- **Practice address fax:** (423) 296-2607
- **Mailing address:** 1334 MACKEY BRANCH DR, SUITE 104, CHATTANOOGA, TN 37421-3471
- **Mailing address phone:** (423) 296-2604
- **Mailing address fax:** (423) 296-2607

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/07/2014
- **Last updated:** 06/23/2014