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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