Healthcare Provider Details

I. General information

NPI: 1083743231
Provider Name (Legal Business Name): SPINAL SCAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 BLUEBIRD DR
GOODLETTSVILLE TN
37072-2304
US

IV. Provider business mailing address

314 BLUEBIRD DR
GOODLETTSVILLE TN
37072-2304
US

V. Phone/Fax

Practice location:
  • Phone: 615-851-5757
  • Fax: 615-851-4607
Mailing address:
  • Phone: 615-851-5757
  • Fax: 615-851-4607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number009317
License Number StateTN

VIII. Authorized Official

Name: JAMES PATRICK ANDERSON
Title or Position: OWNER M EDICAL DIRECTOR
Credential: M.D.
Phone: 615-851-5757