Healthcare Provider Details

I. General information

NPI: 1982988820
Provider Name (Legal Business Name): AMG - SOUTHERN TENNESSEE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2011
Last Update Date: 10/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

186 HOSPITAL RD SUITE 300
WINCHESTER TN
37398-2472
US

IV. Provider business mailing address

186 HOSPITAL RD SUITE 300
WINCHESTER TN
37398-2472
US

V. Phone/Fax

Practice location:
  • Phone: 931-967-2520
  • Fax:
Mailing address:
  • Phone: 931-967-2520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIEL SYKES
Title or Position: VICE PRESIDENT
Credential:
Phone: 615-372-8500