Provider Demographics
NPI:1457690422
Name:AMG HILLSIDE LLC
Entity Type:Organization
Organization Name:AMG HILLSIDE LLC
Other - Org Name:DBA: ALPHA OMEGA FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESS
Authorized Official - Middle Name:N
Authorized Official - Last Name:JUDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-565-1508
Mailing Address - Street 1:1119 E COLLEGE ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PULASKI
Mailing Address - State:TN
Mailing Address - Zip Code:38478-4563
Mailing Address - Country:US
Mailing Address - Phone:931-424-8881
Mailing Address - Fax:931-424-5385
Practice Address - Street 1:1119 E COLLEGE ST
Practice Address - Street 2:SUITE 3
Practice Address - City:PULASKI
Practice Address - State:TN
Practice Address - Zip Code:38478-4563
Practice Address - Country:US
Practice Address - Phone:931-424-8881
Practice Address - Fax:931-424-5385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-11
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty