Provider Demographics
NPI:1467015180
Name:MOTLEY FAMILY MEDICAL PLLC
Entity Type:Organization
Organization Name:MOTLEY FAMILY MEDICAL PLLC
Other - Org Name:MOTLEY FAMILY MEDICAL PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUCINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:615-768-5511
Mailing Address - Street 1:301 WOLVERINE TRL STE 201
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-5656
Mailing Address - Country:US
Mailing Address - Phone:615-768-5511
Mailing Address - Fax:
Practice Address - Street 1:301 WOLVERINE TRL STE 201
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-5656
Practice Address - Country:US
Practice Address - Phone:615-768-5511
Practice Address - Fax:615-768-5519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-18
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1523655Medicaid