Provider Demographics
NPI:1942375571
Name:ADVANCED FAMILY AND URGENT CARE CLINIC,LLC
Entity Type:Organization
Organization Name:ADVANCED FAMILY AND URGENT CARE CLINIC,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:T
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:931-438-8260
Mailing Address - Street 1:PO BOX 1118
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334-1118
Mailing Address - Country:US
Mailing Address - Phone:931-438-8260
Mailing Address - Fax:931-438-8257
Practice Address - Street 1:18 ELDAD RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-7005
Practice Address - Country:US
Practice Address - Phone:931-438-8260
Practice Address - Fax:931-438-8257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5968363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3734234Medicare ID - Type Unspecified
TNQ70785Medicare UPIN