Provider Demographics
NPI:1295928588
Name:WELLSPRING SPORTS MEDICINE AND ORTHOPAEDICS, LLC
Entity type:Organization
Organization Name:WELLSPRING SPORTS MEDICINE AND ORTHOPAEDICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DORIZAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-778-8598
Mailing Address - Street 1:1755 GUNBARREL RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-7137
Mailing Address - Country:US
Mailing Address - Phone:423-778-8598
Mailing Address - Fax:423-778-8597
Practice Address - Street 1:1755 GUNBARREL RD
Practice Address - Street 2:SUITE 102
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-7137
Practice Address - Country:US
Practice Address - Phone:423-778-8598
Practice Address - Fax:423-778-8597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN39362207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty