Provider Demographics
NPI:1093989691
Name:NORTHFIELD FAMILY PRACTICE PC
Entity Type:Organization
Organization Name:NORTHFIELD FAMILY PRACTICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/AO
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PETTIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-793-9900
Mailing Address - Street 1:PO BOX 57
Mailing Address - Street 2:
Mailing Address - City:LA VERGNE
Mailing Address - State:TN
Mailing Address - Zip Code:37086-0057
Mailing Address - Country:US
Mailing Address - Phone:615-793-9900
Mailing Address - Fax:615-793-9990
Practice Address - Street 1:6001 JACKSON SQUARE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LA VERGNE
Practice Address - State:TN
Practice Address - Zip Code:37086-2776
Practice Address - Country:US
Practice Address - Phone:615-793-9900
Practice Address - Fax:615-939-9990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty