Provider Demographics
NPI:1801220546
Name:AMG - SOUTHERN TENNESSEE, LLC
Entity Type:Organization
Organization Name:AMG - SOUTHERN TENNESSEE, LLC
Other - Org Name:WINCHESTER EAR, NOSE AND THROAT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SYKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-372-8500
Mailing Address - Street 1:1383 S COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37398-2414
Mailing Address - Country:US
Mailing Address - Phone:931-962-3500
Mailing Address - Fax:931-962-3545
Practice Address - Street 1:1383 S COLLEGE ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37398-2414
Practice Address - Country:US
Practice Address - Phone:931-962-3500
Practice Address - Fax:931-962-3545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty