Provider Demographics
NPI:1316558869
Name:SOUTHERN FAMILY PRACTICE INC
Entity type:Organization
Organization Name:SOUTHERN FAMILY PRACTICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATTI
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:731-612-2804
Mailing Address - Street 1:738 CURVE NANKIPOO RD
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:TN
Mailing Address - Zip Code:38063-7524
Mailing Address - Country:US
Mailing Address - Phone:731-612-2804
Mailing Address - Fax:
Practice Address - Street 1:124 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:TN
Practice Address - Zip Code:38063-1522
Practice Address - Country:US
Practice Address - Phone:731-612-2804
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty