Healthcare Provider Details

I. General information

NPI: 1568947059
Provider Name (Legal Business Name): TENNESSEE SPORTS MEDICINE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2018
Last Update Date: 10/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7545 BARNETT WAY STE 5
POWELL TN
37849-3565
US

IV. Provider business mailing address

1286 OAK GROVE RD STE 100
BIRMINGHAM AL
35209-6955
US

V. Phone/Fax

Practice location:
  • Phone: 615-553-5000
  • Fax:
Mailing address:
  • Phone: 205-329-7519
  • 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: CHARLES ROBERT KAELIN
Title or Position: OWNER
Credential:
Phone: 615-758-1010