Healthcare Provider Details

I. General information

NPI: 1316131105
Provider Name (Legal Business Name): FAITH FAMILY MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2007
Last Update Date: 08/13/2020
Certification Date: 08/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6050 AIRLINE RD STE 109
ARLINGTON TN
38002-4894
US

IV. Provider business mailing address

6050 AIRLINE RD STE 109
ARLINGTON TN
38002-4894
US

V. Phone/Fax

Practice location:
  • Phone: 901-867-3367
  • Fax: 901-867-3329
Mailing address:
  • Phone: 901-867-3367
  • Fax: 901-867-3329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN7796
License Number StateTN

VIII. Authorized Official

Name: AMY BLAGG
Title or Position: OFFICE MANAGER
Credential:
Phone: 901-867-3367