Healthcare Provider Details

I. General information

NPI: 1699969097
Provider Name (Legal Business Name): NASHVILLE SPORTS MEDICINE AND ORTHOPAEDIC CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 07/24/2020
Certification Date: 07/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2004 HAYES ST STE 700
NASHVILLE TN
37203-5178
US

IV. Provider business mailing address

2004 HAYES ST STE 700
NASHVILLE TN
37203-5178
US

V. Phone/Fax

Practice location:
  • Phone: 615-284-5800
  • Fax: 615-284-5819
Mailing address:
  • Phone: 615-284-5800
  • Fax: 615-284-5819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number17901
License Number StateTN

VIII. Authorized Official

Name: JESSICA N WHITTEN
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 615-760-0877