Organization
PREMIER INTERVENTIONAL PAIN OF MISSISSIPPI LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KERRY TEEL (PRESIDENT)
(770) 643-5501
Entity
Organization
Contact information
Practice address
1400 E UNION ST, GREENVILLE, MS 38703-3246
(770) 643-5501
(404) 941-1304
Mailing address
2655 NORTHWINDS PKWY, ALPHARETTA, GA 30009-2280
(770) 643-5501
(404) 941-1304
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
—
—
207L00000X
Anesthesiology Physician
—
—
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
208VP0000X
Pain Medicine Physician
—
—
208VP0014X
Interventional Pain Medicine Physician
Primary
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
367H00000X
Anesthesiologist Assistant
—
—
Other
Enumeration date
02/04/2014
Last updated
02/05/2014
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