Healthcare Provider Details

I. General information

NPI: 1992147532
Provider Name (Legal Business Name): SPORTI PEDIATRICS, SPORTS AND DANCE MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2013
Last Update Date: 07/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 COOL SPRINGS BLVD SUITE 110
FRANKLIN TN
37067-6474
US

IV. Provider business mailing address

125 COOL SPRINGS BLVD SUITE 110
FRANKLIN TN
37067-6474
US

V. Phone/Fax

Practice location:
  • Phone: 615-329-9960
  • Fax: 615-866-3544
Mailing address:
  • Phone: 615-329-9960
  • Fax: 615-866-3544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number49830
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License Number49830
License Number StateTN

VIII. Authorized Official

Name: LEON R SCOTT
Title or Position: PHYSICIAN/OWNER
Credential: M.D.
Phone: 615-329-9960