Healthcare Provider Details

I. General information

NPI: 1114953239
Provider Name (Legal Business Name): MEMPHIS SPINE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 02/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 EXETER RD SUITE 130
GERMANTOWN TN
38138-3922
US

IV. Provider business mailing address

2120 EXETER RD SUITE 130
GERMANTOWN TN
38138-3900
US

V. Phone/Fax

Practice location:
  • Phone: 901-507-2225
  • Fax: 901-507-7890
Mailing address:
  • Phone: 901-507-2225
  • Fax: 901-507-7890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MRS. SUSI COOPER
Title or Position: OFFICE MANAGER
Credential:
Phone: 901-507-2225