Healthcare Provider Details

I. General information

NPI: 1518215219
Provider Name (Legal Business Name): SOUTHEASTERN SPINE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2012
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

281 NORTH LYERLY STREET SUITE 300
CHATTANOOGA TN
37404-2728
US

IV. Provider business mailing address

281 NORTH LYERLY STREET SUITE 300
CHATTANOOGA TN
37404-2728
US

V. Phone/Fax

Practice location:
  • Phone: 423-693-2175
  • Fax: 888-959-1015
Mailing address:
  • Phone: 423-693-2175
  • Fax: 888-959-1015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: BUFFY BELCHER
Title or Position: COO
Credential:
Phone: 423-693-2175