Organization
SPECIALTY PHYSICIAN GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TABATHA PERRY (MANAGER, PROVIDER ENROLLMENT)
(901) 478-0954
Entity
Organization
Contact information
Practice address
7460 WOLF RIVER BLVD, GERMANTOWN, TN 38138-1760
(901) 763-0200
(901) 761-4002
Mailing address
1211 UNION AVE STE 700, MEMPHIS, TN 38104-6600
(901) 478-0954
(901) 937-6696
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
207RC0001X
Clinical Cardiac Electrophysiology Physician
—
—
207RI0011X
Interventional Cardiology Physician
—
—
2080P0202X
Pediatric Cardiology Physician
—
—
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
—
—
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
—
—
363LA2100X
Acute Care Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1519260
—
TN
05
—
183763002
—
AR
01
—
4269952
BCBS TN
TN
Enumeration date
06/01/2010
Last updated
09/22/2025
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