Provider Demographics
NPI:1598114878
Name:AMG - HILLSIDE, LLC
Entity Type:Organization
Organization Name:AMG - HILLSIDE, LLC
Other - Org Name:SOUTHERN TENNESSEE OBSTETRICS AND GYNECOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MARKET MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-766-4574
Mailing Address - Street 1:PO BOX 635
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:TN
Mailing Address - Zip Code:38478-0635
Mailing Address - Country:US
Mailing Address - Phone:931-292-6644
Mailing Address - Fax:931-292-6648
Practice Address - Street 1:1275 E COLLEGE ST
Practice Address - Street 2:SUITE 1
Practice Address - City:PULASKI
Practice Address - State:TN
Practice Address - Zip Code:38478-4500
Practice Address - Country:US
Practice Address - Phone:931-292-6644
Practice Address - Fax:931-292-6648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-08
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty