Provider Demographics
NPI:1598924110
Name:AMG-HILLSIDE LLC
Entity Type:Organization
Organization Name:AMG-HILLSIDE LLC
Other - Org Name:GILES COUNTY INTERNAL MEDICINE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-372-8500
Mailing Address - Street 1:206 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:TN
Mailing Address - Zip Code:38478-4566
Mailing Address - Country:US
Mailing Address - Phone:931-363-0668
Mailing Address - Fax:931-363-0670
Practice Address - Street 1:206 HILLSIDE DR
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:TN
Practice Address - Zip Code:38478-4566
Practice Address - Country:US
Practice Address - Phone:931-363-0668
Practice Address - Fax:931-363-0670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1506700Medicaid
TN3374856Medicare PIN