Provider Demographics
NPI:1578812087
Name:JAMESTOWN FAMILY CARE CLINIC, LLC
Entity Type:Organization
Organization Name:JAMESTOWN FAMILY CARE CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DNP/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LILLIAN
Authorized Official - Middle Name:TRACYE
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:931-879-5804
Mailing Address - Street 1:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38556-0068
Mailing Address - Country:US
Mailing Address - Phone:931-879-5804
Mailing Address - Fax:
Practice Address - Street 1:1010 OLD HIGHWAY 127 SOUTH
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:TN
Practice Address - Zip Code:38556-0068
Practice Address - Country:US
Practice Address - Phone:931-879-5804
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty