Organization
MID SOUTH PAIN & ANESTHESIA CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PHILLIP E GREEN MD (OWNER)
(901) 761-0800
Entity
Organization
Contact information
Practice address
3087 PROFESSIONAL PLZ, GERMANTOWN, TN 38138-7912
(901) 761-0800
Mailing address
PO BOX 382067, GERMANTOWN, TN 38183-2067
(901) 761-0800
(901) 761-7738
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MD0000017865
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00586809
—
MS
05
—
3722886
—
TN
Enumeration date
01/29/2007
Last updated
07/20/2021
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