Provider Demographics
NPI:1346281706
Name:ADVANCED MEDICAL GROUP, P.C.
Entity Type:Organization
Organization Name:ADVANCED MEDICAL GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAGG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:865-986-8600
Mailing Address - Street 1:615 LEEPER PARKWAY
Mailing Address - Street 2:
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37772-6151
Mailing Address - Country:US
Mailing Address - Phone:865-986-8600
Mailing Address - Fax:865-986-0961
Practice Address - Street 1:615 LEEPER PARKWAY
Practice Address - Street 2:
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37772-6151
Practice Address - Country:US
Practice Address - Phone:865-986-8600
Practice Address - Fax:865-986-0961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN178111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1510839Medicaid
TN1510839Medicaid
TN5555830001Medicare NSC