Provider Demographics
NPI:1215431663
Name:ORTHOONE SPORTS MEDICINE & ORTHOPAEDICS, PLLC
Entity type:Organization
Organization Name:ORTHOONE SPORTS MEDICINE & ORTHOPAEDICS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-853-1174
Mailing Address - Street 1:PO BOX 1866
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38027-1866
Mailing Address - Country:US
Mailing Address - Phone:901-430-8265
Mailing Address - Fax:901-414-1731
Practice Address - Street 1:11851 WILL HARRIS DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38002
Practice Address - Country:US
Practice Address - Phone:901-430-8265
Practice Address - Fax:901-414-1731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty