Provider Demographics
NPI:1962743054
Name:AMG-SOUTHERN TENNESSEE LLC
Entity type:Organization
Organization Name:AMG-SOUTHERN TENNESSEE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-920-7000
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:TN
Mailing Address - Zip Code:37365-0100
Mailing Address - Country:US
Mailing Address - Phone:931-779-3691
Mailing Address - Fax:931-779-3690
Practice Address - Street 1:2578 MAIN ST
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:TN
Practice Address - Zip Code:37365-2730
Practice Address - Country:US
Practice Address - Phone:931-779-3691
Practice Address - Fax:931-779-3690
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMG-SOUTHERN TENNESSEE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-03-14
Last Update Date:2024-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health