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General NPI Number Information
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NPI Number | 1174842181
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Entity Type | Organization
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Legal Business Name | SPECIALTY PHYSICIAN GROUP LLC
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Dates
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Enumeration Date | 06/01/2010
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Last Update Date | 09/22/2025
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Provider Practice Location Address
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Address Line | 7460 WOLF RIVER BLVD
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City | GERMANTOWN
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State | TN
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Zip | 38138-1760
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Country | US
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Telephone | 901-763-0200
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Fax | 901-761-4002
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Provider Business Mailing Address
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Address Line | 1211 UNION AVE STE 700
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City | MEMPHIS
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State | TN
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Zip | 38104-6600
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Country | US
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Telephone | 901-478-0954
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Fax | 901-937-6696
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Authorized Official
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Title or Position | MANAGER, PROVIDER ENROLLMENT
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Name | TABATHA PERRY
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Credential |
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Telephone | 901-478-0954
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0001X
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Taxonomy Name | Clinical Cardiac Electrophysiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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