Healthcare Provider Details

I. General information

NPI: 1710535703
Provider Name (Legal Business Name): PERRY COUNTY MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2019
Last Update Date: 08/13/2020
Certification Date: 08/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7723 CLEARVIEW CHURCH LN STE 200
LYLES TN
37098-1674
US

IV. Provider business mailing address

PO BOX 916
LINDEN TN
37096-0916
US

V. Phone/Fax

Practice location:
  • Phone: 931-670-8318
  • Fax:
Mailing address:
  • Phone: 931-589-2104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: PHILLIP BRADLEY TATUM
Title or Position: CEO
Credential:
Phone: 931-589-2104