Provider Demographics
NPI:1467486597
Name:FAMILY HEALTH CARE OF GALLATIN
Entity Type:Organization
Organization Name:FAMILY HEALTH CARE OF GALLATIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:615-206-0500
Mailing Address - Street 1:831B NASHVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-3103
Mailing Address - Country:US
Mailing Address - Phone:615-206-0500
Mailing Address - Fax:605-206-0092
Practice Address - Street 1:831B NASHVILLE PIKE
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-3103
Practice Address - Country:US
Practice Address - Phone:615-206-0500
Practice Address - Fax:605-206-0092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN11629363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3733235Medicaid
TN3733235Medicaid
TN=========OtherTAX IDENTIFICATION NUMBER