Healthcare Provider Details

I. General information

NPI: 1972745925
Provider Name (Legal Business Name): PSYCHIATRIC ASSOCIATES OF LAWRENCEBURG PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2009
Last Update Date: 04/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 S LOCUST AVE
LAWRENCEBURG TN
38464-4040
US

IV. Provider business mailing address

1331 S LOCUST AVE
LAWRENCEBURG TN
38464-4040
US

V. Phone/Fax

Practice location:
  • Phone: 931-762-6373
  • Fax: 931-762-7421
Mailing address:
  • Phone: 931-762-6373
  • Fax: 931-762-7421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number33975
License Number StateTN

VIII. Authorized Official

Name: DONNA G MCKENZIE
Title or Position: OWNER
Credential: MD
Phone: 931-762-6373