Healthcare Provider Details

I. General information

NPI: 1053670265
Provider Name (Legal Business Name): IMPACT SPORTS MEDICINE & ORTHOPEDICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2012
Last Update Date: 08/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 23RD AVE N SUITE 301
NASHVILLE TN
37203-1513
US

IV. Provider business mailing address

345 23RD AVE N SUITE 301
NASHVILLE TN
37203-1513
US

V. Phone/Fax

Practice location:
  • Phone: 615-329-2520
  • Fax:
Mailing address:
  • Phone: 615-346-4036
  • Fax: 615-346-4036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number36919
License Number StateTN

VIII. Authorized Official

Name: DR. FRANK CLARKE HOLMES
Title or Position: OWNER
Credential: MD
Phone: 615-346-4036