| Organization Name: | AMG -SOUTHERN TENNESSEE LLC |
| NPI Number: | 1154373512 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | WILLIAM GRACEY (COO) |
| Mailing Address: | 155 Hospital Rd Suite B Winchester |
| State: | TN US |
| Postal Code: | 373982494 |
| Phone Number: | 9319624040 |
| Fax Number: | 9319622277 |
| NPI Enumeration Date: | 05/16/2006 |
| NPI Last Update Date: | 06/17/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |