Provider Demographics
NPI:1114676038
Name:SOUTHERN COMFORT-PRIMARY AND CHRONIC CARE MANAGEMENT
Entity Type:Organization
Organization Name:SOUTHERN COMFORT-PRIMARY AND CHRONIC CARE MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:
Authorized Official - First Name:HALEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KIMBRELL
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:931-762-8588
Mailing Address - Street 1:1900 WESTPOINT RD
Mailing Address - Street 2:
Mailing Address - City:WESTPOINT
Mailing Address - State:TN
Mailing Address - Zip Code:38486-5044
Mailing Address - Country:US
Mailing Address - Phone:931-279-1215
Mailing Address - Fax:
Practice Address - Street 1:416 N LOCUST AVE
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-3552
Practice Address - Country:US
Practice Address - Phone:931-762-8588
Practice Address - Fax:931-766-1010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-18
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care