Organization
SOUTHERN SPORTS MEDICINE PORTLAND
Active
Parent organization
SOUTHERN SPORTS MEDICINE INSTITUTE, PLLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTHERN SPORTS MEDICINE INSTITUTE, PLLC
Authorized official
THOMAS L GAUTSCH M.D. (OWNER)
(615) 452-3320
Entity
Organization
Contact information
Practice address
121 VILLAGE DR, STE 102 & 103, PORTLAND, TN 37148-1418
(615) 325-1180
(615) 452-2668
Mailing address
570 HARTSVILLE PIKE, GALLATIN, TN 37066-2450
(615) 452-3320
(615) 452-2668
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MD0000026910
TN
Other
Enumeration date
08/18/2011
Last updated
08/18/2011
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