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General NPI Number Information
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NPI Number | 1629503859
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Entity Type | Organization
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Legal Business Name | PREMIER INTERNAL MEDICINE AND PEDIATRICS PLLC
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Dates
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Enumeration Date | 04/25/2017
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Last Update Date | 11/09/2017
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Provider Practice Location Address
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Address Line | 714 FEDERAL DR
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City | SELMER
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State | TN
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Zip | 38375-1876
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Country | US
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Telephone | 731-540-9083
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Fax | 731-540-9103
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Provider Business Mailing Address
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Address Line | 714 FEDERAL DR
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City | SELMER
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State | TN
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Zip | 38375-1876
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Country | US
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Telephone | 731-540-9083
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Fax | 731-540-9103
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Authorized Official
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Title or Position | OWNER
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Name | DR. KEITH LOU ANTHONY PERKINS JR.
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Credential | M.D.
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Telephone | 731-506-6995
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 46862
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License Number State | TN
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