Provider Demographics
NPI:1114071883
Name:MEDICAL GROUP-SOUTHERN HILLS OF NOLENSVILLE LLC
Entity Type:Organization
Organization Name:MEDICAL GROUP-SOUTHERN HILLS OF NOLENSVILLE LLC
Other - Org Name:SOUTHERN HILLS FAMILY MEDICINE OF NOLENSVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-373-7600
Mailing Address - Street 1:6688 NOLENSVILLE ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027
Mailing Address - Country:US
Mailing Address - Phone:615-941-7501
Mailing Address - Fax:615-941-7502
Practice Address - Street 1:6688 NOLENSVILLE ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027
Practice Address - Country:US
Practice Address - Phone:615-941-7501
Practice Address - Fax:615-941-7502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3736535Medicaid
TN3736535Medicaid
DG1546Medicare PIN