Provider Demographics
NPI:1639324056
Name:FAMILY WELLNESS GROUP OF MIDDLE TENNESSEE LLC
Entity Type:Organization
Organization Name:FAMILY WELLNESS GROUP OF MIDDLE TENNESSEE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT & FAMILY WELLNESS GR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-328-6600
Mailing Address - Street 1:PO BOX 1558
Mailing Address - Street 2:SUMNER REGIONAL HEALTH SYSTEMS INC
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-4747
Mailing Address - Country:US
Mailing Address - Phone:615-822-2400
Mailing Address - Fax:615-822-9641
Practice Address - Street 1:107 GLEN OAK BLVD STE 201
Practice Address - Street 2:GLEN OAKS CENTER
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-3000
Practice Address - Country:US
Practice Address - Phone:615-822-2400
Practice Address - Fax:615-822-9641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-26
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty