Provider Demographics
NPI:1003252040
Name:AMG - SOUTHERN TENNESSEE, LLC
Entity Type:Organization
Organization Name:AMG - SOUTHERN TENNESSEE, LLC
Other - Org Name:SOUTHERN TENNESSEE PRIMARY CARE - WALKER FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SYKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-372-8500
Mailing Address - Street 1:183 HOSPITAL RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:WINCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37398-2470
Mailing Address - Country:US
Mailing Address - Phone:931-967-8222
Mailing Address - Fax:931-967-8226
Practice Address - Street 1:183 HOSPITAL RD
Practice Address - Street 2:SUITE D
Practice Address - City:WINCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37398-2470
Practice Address - Country:US
Practice Address - Phone:931-967-8222
Practice Address - Fax:931-967-8226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-17
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty