Provider Demographics
NPI:1306372925
Name:ATLAS MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:ATLAS MEDICAL GROUP, LLC
Other - Org Name:GENEXIS HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:W
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, APN,FNP-BC
Authorized Official - Phone:731-736-4196
Mailing Address - Street 1:210 N LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-6222
Mailing Address - Country:US
Mailing Address - Phone:731-736-4196
Mailing Address - Fax:731-736-4195
Practice Address - Street 1:210 N LIBERTY ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-6222
Practice Address - Country:US
Practice Address - Phone:731-736-4196
Practice Address - Fax:731-736-4195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-02
Last Update Date:2017-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7239363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ09565Medicare UPIN