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Organization
SOUTHERN ORTHOPEDICS AND SPORTS MEDICINE, LLC
Active
Organization
SOUTHERN ORTHOPEDICS AND SPORTS MEDICINE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL KYLE BURTNETT (SVP OF OUTPATIENT SERVICES, TENET)
(469) 893-2153
Entity
Organization
Contact information
Practice address
851 LEONARD FULGHUM BLVD, SUITE 101, MT PLEASANT, SC 29464-3787
(843) 971-9350
(843) 971-9351
Mailing address
851 LEONARD FULGHUM BLVD, SUITE 101, MT PLEASANT, SC 29464-3787
(843) 971-9350
(843) 971-9351
Taxonomy
Speciality
Code
Description
License number
State
207PS0010X
Sports Medicine (Emergency Medicine) Physician
—
—
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP5001
—
SC
Enumeration date
08/27/2008
Last updated
06/23/2016
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