Healthcare Provider Details

I. General information

NPI: 1851745434
Provider Name (Legal Business Name): AMG - SOUTHERN TENNESSEE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2016
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 COWAN HWY
WINCHESTER TN
37398-2627
US

IV. Provider business mailing address

PO BOX 399
WINCHESTER TN
37398-0399
US

V. Phone/Fax

Practice location:
  • Phone: 931-962-3500
  • Fax: 931-962-3545
Mailing address:
  • Phone: 931-962-3500
  • Fax: 931-962-3545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: JESS JUDY
Title or Position: PRESIDENT
Credential:
Phone: 615-920-7214