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General NPI Number Information
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NPI Number | 1457998379
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Entity Type | Organization
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Legal Business Name | SPECIALTY ORTHOPEDIC GROUP TENNESSEE PLLC
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Dates
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Enumeration Date | 12/10/2019
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 602 RED BOILING SPRINGS RD STE 106
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City | LAFAYETTE
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State | TN
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Zip | 37083-1316
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Country | US
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Telephone | 615-237-5410
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Fax | 615-237-5411
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Provider Business Mailing Address
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Address Line | PO BOX 81
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City | CASTALIAN SPRINGS
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State | TN
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Zip | 37031-0081
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Country | US
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Telephone | 615-237-5431
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Fax | 615-237-5411
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Authorized Official
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Title or Position | BUSINESS OWNER
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Name | BEAU CASSIDY
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Credential | FNP-C
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Telephone | 615-237-5410
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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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