Organization
TULLAHOMA ORTHOPAEDICS & SPORTS MEDICINE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY R STEVENS DO (PARTNER)
(931) 455-8676
Entity
Organization
Contact information
Practice address
1816 N WASHINGTON ST, SUITE 100, TULLAHOMA, TN 37388-2222
(931) 455-8676
(931) 455-9983
Mailing address
1816 N WASHINGTON ST, SUITE 100, TULLAHOMA, TN 37388-2222
(931) 455-8676
(931) 455-9983
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10070483
AMERIGROUP
TN
01
—
166220000
US DEPT OF LABOR WORKER COMP
—
01
—
3093519
BLUE CROSS
TN
05
—
3713655
—
TN
Enumeration date
09/14/2005
Last updated
04/13/2011
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