Provider Demographics
NPI:1932308590
Name:FAMILY PRACTICE,LLC
Entity Type:Organization
Organization Name:FAMILY PRACTICE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCGRATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-885-3866
Mailing Address - Street 1:1720 E REELFOOT AVE
Mailing Address - Street 2:SUITE 202A
Mailing Address - City:UNION CITY
Mailing Address - State:TN
Mailing Address - Zip Code:38261-6047
Mailing Address - Country:US
Mailing Address - Phone:731-885-3866
Mailing Address - Fax:731-536-1090
Practice Address - Street 1:1720 E REELFOOT AVE
Practice Address - Street 2:SUITE 202A
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-6047
Practice Address - Country:US
Practice Address - Phone:731-885-3866
Practice Address - Fax:731-536-1090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Single Specialty