Provider Demographics
NPI:1992966097
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:COO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GRACEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-372-8500
Mailing Address - Street 1:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:COALMONT
Mailing Address - State:TN
Mailing Address - Zip Code:37313-0068
Mailing Address - Country:US
Mailing Address - Phone:931-692-0010
Mailing Address - Fax:931-692-0012
Practice Address - Street 1:68 SOUTH INDUSTRIAL PARK ROAD
Practice Address - Street 2:
Practice Address - City:COALMONT
Practice Address - State:TN
Practice Address - Zip Code:37313
Practice Address - Country:US
Practice Address - Phone:931-692-0010
Practice Address - Fax:931-692-0012
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMG-SOUTHERN TENNESSEE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty