Southern Sports Medicine Portland

NPI #1417237728 in Portland, Tennessee

Provider Information

NPI Number: 1417237728
Entity Type: Organization
Organization Name: Southern Sports Medicine Portland
Subpart: Yes (part of a larger organization)
Parent Organization: SOUTHERN SPORTS MEDICINE INSTITUTE, PLLC
Primary Specialty: Specialist
Enumeration Date: Aug 18, 2011
Last Updated: Aug 18, 2011

Practice Location

Address: 121 VILLAGE DR
Address 2: STE 102 & 103
City: Portland
State: Tennessee
ZIP Code: 37148-1418
Phone: (615) 325-1180

Authorized Official

Name: THOMAS L GAUTSCH, M.D.
Title: OWNER
Phone: (615) 452-3320

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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