Healthcare Provider Details

I. General information

NPI: 1255602587
Provider Name (Legal Business Name): SPG II LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2012
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7705 POPLAR AVE STE 310
GERMANTOWN TN
38138-3930
US

IV. Provider business mailing address

1211 UNION AVE STE 700
MEMPHIS TN
38104-6600
US

V. Phone/Fax

Practice location:
  • Phone: 901-516-6300
  • Fax:
Mailing address:
  • Phone: 901-478-0954
  • Fax: 901-937-6696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: TABATHA PERRY
Title or Position: MANAGER, PROVIDER ENROLLMENT
Credential:
Phone: 901-478-0954