Provider Demographics
NPI:1952869133
Name:ORTHO SPINE
Entity type:Organization
Organization Name:ORTHO SPINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:DINKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:615-502-0952
Mailing Address - Street 1:3320 PERIMETER HILL DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-4123
Mailing Address - Country:US
Mailing Address - Phone:615-502-0952
Mailing Address - Fax:615-988-1540
Practice Address - Street 1:3320 PERIMETER HILL DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-4123
Practice Address - Country:US
Practice Address - Phone:615-502-0952
Practice Address - Fax:615-988-1540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-07
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ046108Medicaid