Provider Demographics
NPI:1578882320
Name:ADVANCED MEDICAL CONSULTANTS TWO L.L.C.
Entity Type:Organization
Organization Name:ADVANCED MEDICAL CONSULTANTS TWO L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRAYFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-907-9771
Mailing Address - Street 1:758 HIGHWAY 46 S SUITE A
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055
Mailing Address - Country:US
Mailing Address - Phone:615-907-9771
Mailing Address - Fax:615-907-9545
Practice Address - Street 1:758 HIGHWAY 46 S SUITE A
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055
Practice Address - Country:US
Practice Address - Phone:615-907-9771
Practice Address - Fax:615-907-9545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-19
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA011363A00000X
TNPA095363A00000X
TNRN120814363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty