Healthcare Provider Details

I. General information

NPI: 1003994047
Provider Name (Legal Business Name): SCOLIOSIS & SPINE SURGERY CLINIC OF MEMPHIS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 02/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6005 PARK AVE SUITE 400
MEMPHIS TN
38119-5214
US

IV. Provider business mailing address

6005 PARK AVE SUITE 400
MEMPHIS TN
38119-5214
US

V. Phone/Fax

Practice location:
  • Phone: 901-767-9500
  • Fax: 901-767-0911
Mailing address:
  • Phone: 901-767-9500
  • Fax: 901-767-0911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: DOUGLAS A LINVILLE
Title or Position: OWNER
Credential: M.D.
Phone: 901-767-9500