Healthcare Provider Details

I. General information

NPI: 1942716709
Provider Name (Legal Business Name): TENNESSEE SPORTS MEDICINE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2017
Last Update Date: 07/15/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 N THOMPSON LN STE 1H
MURFREESBORO TN
37129-4340
US

IV. Provider business mailing address

4998 CROSSINGS CIR STE 200
MOUNT JULIET TN
37122-0018
US

V. Phone/Fax

Practice location:
  • Phone: 615-553-5000
  • Fax:
Mailing address:
  • Phone: 615-553-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLES ROBERT KAELIN
Title or Position: OWNER
Credential: MD
Phone: 615-553-5000