Southeastern Pain PLLC

Primary specialty

Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X

Legal business name

SOUTHEASTERN PAIN PLLC

Practice address

1236 Knoxville Hwy
Wartburg, TN 37887

Phone

(770) 548-2182

NPI assigned

Nov 2, 2017

Last updated

Jun 1, 2018By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Gary Chase Black, MD

Title

Owner

Phone

(770) 548-2182

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1509580800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1527811200000",
    "number": "1992217723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3671 BURNING BUSH RD",
            "city": "RINGGOLD",
            "state": "GA",
            "postal_code": "307365725",
            "telephone_number": "770-548-2182"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1236 KNOXVILLE HWY",
            "city": "WARTBURG",
            "state": "TN",
            "postal_code": "37887",
            "telephone_number": "770-548-2182"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN PAIN PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-02",
        "last_updated": "2018-06-01",
        "status": "A",
        "authorized_official_last_name": "BLACK",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "CHASE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-548-2182",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "0099",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q035114",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RRMEDICARE PTAN",
            "identifier": "DY2044",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Samantha Ashley Seiber, LPN
• Allison H Sexton, PHARMD
• Judy D Smith, FNP
• Lela McNew Smith, LMT, RCR
• Samantha Snow, COTA
• Nikki P Spence, R.D.,L.D.N.
• State of Tennessee (Morgan County Health Department)
• Andrew Steidl
• Jessyca Sterling
• Summit Medical Group, PLLC (Summit Medical Group at Wartburg)

• Pain Medicine (Anesthesiology) Physician in Wartburg, TN
• Providers in Wartburg, TN by specialty
• Pain Medicine (Anesthesiology) Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.