MEDICARE: AMG-SOUTHERN TENNESSEE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1649138827
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMG-SOUTHERN TENNESSEE LLC

Provider Business Mailing Address
First Line	:	1610 MCARTHUR ST
Second Line	:
City	:	MANCHESTER
State	:	TN
Zip	:	37355-2522
Country	:	US
Telephone Number	:	931-962-3500
Fax Number	:	931-967-0175

Provider Business Practice Location Address
First Line	:	1610 MCARTHUR ST
Second Line	:
City	:	MANCHESTER
State	:	TN
Zip	:	37355-2522
Country	:	US
Telephone Number	:	931-962-3500
Fax Number	:

Authorized Official
Title or Position	:	SECRETARY
Name	:	CHARLOTTE LAWRENCE
Credential	:
Telephone Number	:	615-920-7000

Provider Enumeration Date	:	01/14/2026
Last Update Date	:	01/18/2026

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