MEDICARE: U.S. MEDICAL GROUP OF TENNESSEE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1073358453
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	U.S. MEDICAL GROUP OF TENNESSEE, LLC

Provider Business Mailing Address
First Line	:	1405 S ORANGE AVE STE 603
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32806
Country	:	US
Telephone Number	:	407-849-2288
Fax Number	:	407-849-6412

Provider Business Practice Location Address
First Line	:	200 GULFSTREAM RD
Second Line	:
City	:	GARDEN CITY
State	:	GA
Zip	:	31408-9677
Country	:	US
Telephone Number	:	912-713-2306
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	CONNIE M GRESHAM
Credential	:
Telephone Number	:	407-849-2288

Provider Enumeration Date	:	06/27/2024
Last Update Date	:	01/12/2026

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