| Organization Name: | PROFESSIONAL PAIN MANAGEMENT, LLC |
| NPI Number: | 1003109646 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DAVID S. COFER (OWNER) |
| Mailing Address: | 301 Keith St Sw Suite 204 Cleveland |
| State: | TN US |
| Postal Code: | 373115808 |
| Phone Number: | 4237907500 |
| Fax Number: | 4237905299 |
| NPI Enumeration Date: | 05/16/2011 |
| NPI Last Update Date: | 05/16/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 13528 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |