Provider Demographics
NPI:1063179356
Name:TENNESSEE NEUROSURGERY SOLUTIONS
Entity type:Organization
Organization Name:TENNESSEE NEUROSURGERY SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING PERSIB
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:COPPEDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-206-8631
Mailing Address - Street 1:1707 ALPINE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-3562
Mailing Address - Country:US
Mailing Address - Phone:931-206-8631
Mailing Address - Fax:
Practice Address - Street 1:1707 ALPINE DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-3562
Practice Address - Country:US
Practice Address - Phone:770-405-5746
Practice Address - Fax:933-933-7645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-21
Last Update Date:2021-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty