Provider Demographics
NPI:1629035654
Name:AMERICA'S FAMILY DOCTORS, PLLC
Entity Type:Organization
Organization Name:AMERICA'S FAMILY DOCTORS, PLLC
Other - Org Name:TENNESSEE FAMILY DOCTORS, PLLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SREEDHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMUDRALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-373-2000
Mailing Address - Street 1:1195 OLD HICKORY BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4239
Mailing Address - Country:US
Mailing Address - Phone:615-373-2000
Mailing Address - Fax:615-891-5021
Practice Address - Street 1:1195 OLD HICKORY BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-4239
Practice Address - Country:US
Practice Address - Phone:615-373-2000
Practice Address - Fax:615-891-5021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000036148207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3377514Medicaid
TN3377514Medicaid