Healthcare Provider Details

I. General information

NPI: 1457998379
Provider Name (Legal Business Name): SPECIALTY ORTHOPEDIC GROUP TENNESSEE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2019
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 RED BOILING SPRINGS RD STE 106
LAFAYETTE TN
37083-1316
US

IV. Provider business mailing address

PO BOX 81
CASTALIAN SPRINGS TN
37031-0081
US

V. Phone/Fax

Practice location:
  • Phone: 615-237-5410
  • Fax: 615-237-5411
Mailing address:
  • Phone: 615-237-5431
  • Fax: 615-237-5411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: BEAU CASSIDY
Title or Position: BUSINESS OWNER
Credential: FNP-C
Phone: 615-237-5410