Healthcare Provider Details

I. General information

NPI: 1184666489
Provider Name (Legal Business Name): AMG-SOUTHERN TENNESSEE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 07/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 N JACKSON ST SUITE B
TULLAHOMA TN
37388-2290
US

IV. Provider business mailing address

161 SHIRLEY DR
WINCHESTER TN
37398-2256
US

V. Phone/Fax

Practice location:
  • Phone: 931-962-0450
  • Fax: 931-962-0470
Mailing address:
  • Phone: 931-962-0450
  • Fax: 931-962-0470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT SCOTT RAPLEE
Title or Position: GROUP PRESIDENT
Credential:
Phone: 615-372-8500