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General NPI Number Information
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NPI Number | 1255602587
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Entity Type | Organization
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Legal Business Name | SPG II LLC
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Dates
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Enumeration Date | 01/18/2012
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Last Update Date | 09/22/2025
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Provider Practice Location Address
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Address Line | 7705 POPLAR AVE STE 310
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City | GERMANTOWN
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State | TN
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Zip | 38138-3930
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Country | US
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Telephone | 901-516-6300
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Fax |
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery 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 | 207VG0400X
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Taxonomy Name | Gynecology Physician
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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