Healthcare Provider Details

I. General information

NPI: 1982745014
Provider Name (Legal Business Name): SOUTHERN SPINE CENTER PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5651 FRIST BLVD SUITE 409
HERMITAGE TN
37076-2054
US

IV. Provider business mailing address

5651 FRIST BLVD SUITE 409
HERMITAGE TN
37076-2054
US

V. Phone/Fax

Practice location:
  • Phone: 615-885-0200
  • Fax: 615-885-0267
Mailing address:
  • Phone: 615-885-0200
  • Fax: 615-885-0267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TAREK G ELALAYLI
Title or Position: M.D. PRESIDENT
Credential: M.D.
Phone: 615-885-0200