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General NPI Number Information
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NPI Number | 1467555763
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Entity Type | Organization
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Legal Business Name | PRIMARY CARE SPECIALISTS SOUTH PLLC
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Dates
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Enumeration Date | 09/06/2006
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Last Update Date | 03/30/2015
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Provider Practice Location Address
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Address Line | 1385 S HIGHLAND AVE SUITE B1
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City | JACKSON
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State | TN
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Zip | 38301-7525
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Country | US
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Telephone | 731-427-0470
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Fax | 731-427-0995
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Provider Business Mailing Address
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Address Line | PO BOX 9274
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City | JACKSON
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State | TN
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Zip | 38314-9274
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Country | US
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Telephone | 731-427-0470
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Fax | 731-427-0995
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Authorized Official
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Title or Position | OWNER
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Name | DR JOHN MICHAEL BRILEY
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Credential | DNP
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Telephone | 731-427-0470
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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