=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336285535
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BONE & JOINT SPECIALISTS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1004 CORNERSTONE DR
-----------------------------------------------------
City | PARIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38242-5847
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 731-644-0474
-----------------------------------------------------
Fax | 731-644-1892
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1004 CORNERSTONE DR
-----------------------------------------------------
City | PARIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38242-5847
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 731-644-0474
-----------------------------------------------------
Fax | 731-644-1892
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF MANAGER
-----------------------------------------------------
Name | DR. GERALD BLAKE CHANDLER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 731-644-0474
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------