Provider Demographics
NPI: | 1851745434 |
---|---|
Name: | AMG - SOUTHERN TENNESSEE, LLC |
Entity Type: | Organization |
Organization Name: | AMG - SOUTHERN TENNESSEE, LLC |
Other - Org Name: | SOUTHERN TENNESSEE PSYCHIATRY |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JESS |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | JUDY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 615-920-7214 |
Mailing Address - Street 1: | PO BOX 399 |
Mailing Address - Street 2: | |
Mailing Address - City: | WINCHESTER |
Mailing Address - State: | TN |
Mailing Address - Zip Code: | 37398-0399 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 931-962-3500 |
Mailing Address - Fax: | 931-962-3545 |
Practice Address - Street 1: | 2230 COWAN HWY |
Practice Address - Street 2: | |
Practice Address - City: | WINCHESTER |
Practice Address - State: | TN |
Practice Address - Zip Code: | 37398-2627 |
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: | 2016-04-20 |
Last Update Date: | 2016-04-20 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |