Organization Name: | AMG CROCKETT LLC |
NPI Number: | 1063802767 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CASEY WILLIS (MANAGER) |
Mailing Address: | 1908 N Locust Ave Lawrenceburg |
State: | TN US |
Postal Code: | 384642334 |
Phone Number: | 9312447600 |
Fax Number: | 9312447601 |
NPI Enumeration Date: | 02/02/2015 |
NPI Last Update Date: | 04/28/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |