Provider Demographics
NPI:1467555763
Name:PRIMARY CARE SPECIALISTS SOUTH PLLC
Entity Type:Organization
Organization Name:PRIMARY CARE SPECIALISTS SOUTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DR JOHN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BRILEY
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:731-427-0470
Mailing Address - Street 1:PO BOX 9274
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38314-9274
Mailing Address - Country:US
Mailing Address - Phone:731-427-0470
Mailing Address - Fax:731-427-0995
Practice Address - Street 1:1385 S HIGHLAND AVE
Practice Address - Street 2:SUITE B1
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-7525
Practice Address - Country:US
Practice Address - Phone:731-427-0470
Practice Address - Fax:731-427-0995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3735747Medicaid
TN3735747Medicare PIN