Organization
SPG II 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
7705 POPLAR AVE STE 310, GERMANTOWN, TN 38138-3930
(901) 516-6300
Mailing address
1211 UNION AVE STE 700, MEMPHIS, TN 38104-6600
(901) 478-0954
(901) 937-6696
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
2080P0202X
Pediatric Cardiology Physician
—
—
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02932831
—
MS
05
—
1527696
—
TN
05
—
192594002
—
AR
01
—
4321634
BCBS
TN
01
—
DT0543
RAILROAD MEDICARE
TN
Enumeration date
01/18/2012
Last updated
09/22/2025
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