Healthcare Provider Details

I. General information

NPI: 1083789176
Provider Name (Legal Business Name): PREMIER ORTHOPAEDICS & SPORTS MEDICINE, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 09/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5651 FRIST BLVD SUITE 515
HERMITAGE TN
37076-2054
US

IV. Provider business mailing address

PO BOX 370
FORTSON GA
31808-0370
US

V. Phone/Fax

Practice location:
  • Phone: 615-889-3501
  • Fax: 615-889-3349
Mailing address:
  • Phone: 706-324-6661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMY BENCHWICK
Title or Position: DIRECTOR OF CREDENTIALING
Credential:
Phone: 706-324-6661