Healthcare Provider Details

I. General information

NPI: 1730763145
Provider Name (Legal Business Name): TENNESSEE ORTHOPEDIC AND SPINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 05/11/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1661 INTERNATIONAL DR SUITE 400
MEMPHIS TN
38120
US

IV. Provider business mailing address

1661 INTERNATIONAL DR SUITE 400
MEMPHIS TN
38120
US

V. Phone/Fax

Practice location:
  • Phone: 844-434-7627
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: MR. JACOB MURRAY
Title or Position: PRESIDENT
Credential:
Phone: 903-738-5186