Healthcare Provider Details

I. General information

NPI: 1336199041
Provider Name (Legal Business Name): FAMILY HEALTH GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 06/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 J V MANGUAT DR
WAYNESBORO TN
38485-2440
US

IV. Provider business mailing address

854 W JAMES CAMPBELL BLVD SUITE 303
COLUMBIA TN
38401-4659
US

V. Phone/Fax

Practice location:
  • Phone: 931-722-2800
  • Fax: 931-722-9627
Mailing address:
  • Phone: 931-540-4255
  • Fax: 931-490-4654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. HAROLD E PRESTON
Title or Position: CEO
Credential:
Phone: 931-540-4255