Healthcare Provider Details

I. General information

NPI: 1588255319
Provider Name (Legal Business Name): SPINE AND JOINT REGENERATIVE MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2021
Last Update Date: 02/03/2021
Certification Date: 02/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6711 MOUNTAIN VIEW RD STE 115
OOLTEWAH TN
37363-6667
US

IV. Provider business mailing address

6711 MOUNTAIN VIEW RD STE 115
OOLTEWAH TN
37363-6667
US

V. Phone/Fax

Practice location:
  • Phone: 423-541-7700
  • Fax:
Mailing address:
  • Phone: 423-541-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER LEWIS
Title or Position: OWNER
Credential: DC
Phone: 706-581-3465