Healthcare Provider Details

I. General information

NPI: 1235178518
Provider Name (Legal Business Name): NORTH JACKSON FAMILY CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 GREYSTONE SQUARE
JACKSON TN
38305
US

IV. Provider business mailing address

1004 GREYSTONE SQUARE
JACKSON TN
38305
US

V. Phone/Fax

Practice location:
  • Phone: 731-668-7375
  • Fax:
Mailing address:
  • Phone: 731-668-7375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AMY BRYANT
Title or Position: OWNER
Credential: FNP
Phone: 731-668-7375