Provider Demographics
NPI:1740391804
Name:SUTHERLAND CARDIOLOGY CLINIC, P.C.
Entity Type:Organization
Organization Name:SUTHERLAND CARDIOLOGY CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:J.
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:LOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-763-0200
Mailing Address - Street 1:7460 WOLF RIVER BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138
Mailing Address - Country:US
Mailing Address - Phone:901-763-0200
Mailing Address - Fax:901-260-1737
Practice Address - Street 1:7460 WOLF RIVER BOULEVARD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138
Practice Address - Country:US
Practice Address - Phone:901-763-0200
Practice Address - Fax:901-260-1737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty