Healthcare Provider Details

I. General information

NPI: 1467555763
Provider Name (Legal Business Name): PRIMARY CARE SPECIALISTS SOUTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 03/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1385 S HIGHLAND AVE SUITE B1
JACKSON TN
38301-7525
US

IV. Provider business mailing address

PO BOX 9274
JACKSON TN
38314-9274
US

V. Phone/Fax

Practice location:
  • Phone: 731-427-0470
  • Fax: 731-427-0995
Mailing address:
  • Phone: 731-427-0470
  • Fax: 731-427-0995

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: DR JOHN MICHAEL BRILEY
Title or Position: OWNER
Credential: DNP
Phone: 731-427-0470