Provider Demographics
NPI:1417299744
Name:AMG SOUTHERN TENNESSEE, LLC
Entity Type:Organization
Organization Name:AMG SOUTHERN TENNESSEE, LLC
Other - Org Name:SOUTHERN TENNESSEE PULMONARY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESS
Authorized Official - Middle Name:
Authorized Official - Last Name:JUDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-372-8500
Mailing Address - Street 1:155 HOSPITAL RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:WINCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37398-2494
Mailing Address - Country:US
Mailing Address - Phone:931-967-8111
Mailing Address - Fax:
Practice Address - Street 1:155 HOSPITAL RD
Practice Address - Street 2:SUITE C
Practice Address - City:WINCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37398-2494
Practice Address - Country:US
Practice Address - Phone:931-967-8111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-25
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty