Provider Demographics
NPI:1700227436
Name:MILLINGTON FAMILY MEDICINE, INC.
Entity Type:Organization
Organization Name:MILLINGTON FAMILY MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, APN-FNP-BC
Authorized Official - Phone:901-872-3114
Mailing Address - Street 1:8510 WILKINSVILLE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MILLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38053-1537
Mailing Address - Country:US
Mailing Address - Phone:901-872-3114
Mailing Address - Fax:901-872-3116
Practice Address - Street 1:8510 WILKINSVILLE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:MILLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38053-1537
Practice Address - Country:US
Practice Address - Phone:901-872-3114
Practice Address - Fax:901-872-3116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty