Provider Demographics
NPI:1538234224
Name:SOUTHERN ONCOLOGY SPECIALISTS PC
Entity type:Organization
Organization Name:SOUTHERN ONCOLOGY SPECIALISTS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-373-5544
Mailing Address - Street 1:6144 BRENTWOOD CHASE DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4443
Mailing Address - Country:US
Mailing Address - Phone:615-373-5544
Mailing Address - Fax:
Practice Address - Street 1:6144 BRENTWOOD CHASE DR
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-4443
Practice Address - Country:US
Practice Address - Phone:615-373-5544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13534207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3065691Medicaid
TN0136553OtherBLUE CROSS
TN0136553OtherBLUE CROSS