| Organization Name: | AMG - SOUTHERN TENNESSEE LLC |
| NPI Number: | 1164789467 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | WILLIAM GRACY (COO) |
| Mailing Address: | 1894 Cowan Hwy Suite 2 Winchester |
| State: | TN US |
| Postal Code: | 373982624 |
| Phone Number: | 9319624040 |
| Fax Number: | 9319622277 |
| NPI Enumeration Date: | 04/12/2012 |
| NPI Last Update Date: | 05/28/2013 |
| 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: | |