Provider Demographics
NPI:1891459152
Name:THIRD CIRCLE MEDICAL CLINIC, LLC
Entity Type:Organization
Organization Name:THIRD CIRCLE MEDICAL CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:CENCHREA
Authorized Official - Middle Name:
Authorized Official - Last Name:LANIER
Authorized Official - Suffix:
Authorized Official - Credentials:MSN-ANP-BC
Authorized Official - Phone:615-714-8715
Mailing Address - Street 1:6011 TROTWOOD AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-7022
Mailing Address - Country:US
Mailing Address - Phone:931-505-8014
Mailing Address - Fax:931-505-8013
Practice Address - Street 1:6011 TROTWOOD AVE STE 400
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-7022
Practice Address - Country:US
Practice Address - Phone:615-505-8014
Practice Address - Fax:931-505-8013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-23
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN16491OtherSTATE OF TENNESSEE BOARD OF NURSING
TN114731OtherSTATE OF TENNESSEE
TN1962775999OtherNPPES