Healthcare Provider Details

I. General information

NPI: 1891459152
Provider Name (Legal Business Name): THIRD CIRCLE MEDICAL CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2021
Last Update Date: 05/19/2022
Certification Date: 05/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6011 TROTWOOD AVE STE 400
COLUMBIA TN
38401-7022
US

IV. Provider business mailing address

6011 TROTWOOD AVE STE 400
COLUMBIA TN
38401-7022
US

V. Phone/Fax

Practice location:
  • Phone: 615-505-8014
  • Fax: 931-505-8013
Mailing address:
  • Phone: 931-505-8014
  • Fax: 931-505-8013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CENCHREA LANIER
Title or Position: NP
Credential: MSN-ANP-BC
Phone: 615-714-8715