Provider Demographics
NPI:1982745014
Name:SOUTHERN SPINE CENTER PLC
Entity Type:Organization
Organization Name:SOUTHERN SPINE CENTER PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D. PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAREK
Authorized Official - Middle Name:G
Authorized Official - Last Name:ELALAYLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-885-0200
Mailing Address - Street 1:5651 FRIST BLVD
Mailing Address - Street 2:SUITE 409
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-2054
Mailing Address - Country:US
Mailing Address - Phone:615-885-0200
Mailing Address - Fax:615-885-0267
Practice Address - Street 1:5651 FRIST BLVD
Practice Address - Street 2:SUITE 409
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-2054
Practice Address - Country:US
Practice Address - Phone:615-885-0200
Practice Address - Fax:615-885-0267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN=========OtherWORKMANS COMP
=========OtherTRICARE
TN3727753Medicare ID - Type Unspecified