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Organization

PROVIDENCE PHYSICIAN PRACTICES LLC

Active
Other names
Providence Orthopedics
Organization subpart
No

Provider details

NPI number
Authorized official
KATHY TEAGUE (CORPORATE SECRETARY)
(615) 920-7646
Entity
Organization

Contact information

Practice address
114 GATEWAY CORPORATE BLVD STE 220A, COLUMBIA, SC 29203-9785
(803) 365-8660
(803) 217-4178
Mailing address
330 SEVEN SPRINGS WAY, BRENTWOOD, TN 37027-5098
(615) 920-7000

Taxonomy

Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary

Other

Enumeration date
04/09/2020
Last updated
04/09/2020
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