Provider Demographics
NPI:1689843153
Name:AMG-CROCKETT, LLC
Entity Type:Organization
Organization Name:AMG-CROCKETT, LLC
Other - Org Name:FIRST CHOICE HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIVISION PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONE
Authorized Official - Middle Name:LAW
Authorized Official - Last Name:KOFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-372-8503
Mailing Address - Street 1:PO BOX 847
Mailing Address - Street 2:US HIGHWAY 43 SOUTH
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-0847
Mailing Address - Country:US
Mailing Address - Phone:931-762-6571
Mailing Address - Fax:931-766-3339
Practice Address - Street 1:184 PROSSER RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-4233
Practice Address - Country:US
Practice Address - Phone:931-762-1800
Practice Address - Fax:931-762-9155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty