Healthcare Provider Details

I. General information

NPI: 1962743054
Provider Name (Legal Business Name): AMG-SOUTHERN TENNESSEE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2013
Last Update Date: 09/14/2024
Certification Date: 09/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2578 MAIN ST
PALMER TN
37365-2730
US

IV. Provider business mailing address

PO BOX 100
PALMER TN
37365-0100
US

V. Phone/Fax

Practice location:
  • Phone: 931-779-3691
  • Fax: 931-779-3690
Mailing address:
  • Phone: 931-779-3691
  • Fax: 931-779-3690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHARLOTTE LAWRENCE
Title or Position: SECRETARY
Credential:
Phone: 615-920-7000