Healthcare Provider Details

I. General information

NPI: 1043371016
Provider Name (Legal Business Name): SOUTHERN TENNESSEE ORTHOPAEDIC & HAND SURGERY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 08/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 E COLLEGE ST SUITE 1
PULASKI TN
38478-4500
US

IV. Provider business mailing address

1275 E COLLEGE ST SUITE 1
PULASKI TN
38478-4500
US

V. Phone/Fax

Practice location:
  • Phone: 931-363-2123
  • Fax: 931-363-8123
Mailing address:
  • Phone: 931-363-2123
  • Fax: 931-363-8123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number5505880001
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD16256
License Number StateTN

VIII. Authorized Official

Name: DR. ROBERT COLLINS
Title or Position: OWNER-PHYSICIAN
Credential:
Phone: 931-363-2123