Healthcare Provider Details

I. General information

NPI: 1215431663
Provider Name (Legal Business Name): ORTHOONE SPORTS MEDICINE & ORTHOPAEDICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 03/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11851 WILL HARRIS DR
ARLINGTON TN
38002
US

IV. Provider business mailing address

PO BOX 1866
COLLIERVILLE TN
38027-1866
US

V. Phone/Fax

Practice location:
  • Phone: 901-430-8265
  • Fax: 901-414-1731
Mailing address:
  • Phone: 901-430-8265
  • Fax: 901-414-1731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: SHANNA SMITH
Title or Position: DIRECTOR
Credential:
Phone: 901-853-1174