Provider Demographics
NPI:1952743643
Name:AMG - SOUTHERN TENNESSEE, LLC
Entity type:Organization
Organization Name:AMG - SOUTHERN TENNESSEE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SYKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-372-8500
Mailing Address - Street 1:81 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37398-2401
Mailing Address - Country:US
Mailing Address - Phone:931-967-7171
Mailing Address - Fax:931-967-3131
Practice Address - Street 1:81 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37398-2401
Practice Address - Country:US
Practice Address - Phone:931-967-7171
Practice Address - Fax:931-967-3131
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMG - SOUTHERN TENNESSEE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty