# AWCC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205562279
- **Authorized official:** DR. ETHAN KELLUM MD (OWNER)
- **Authorized official phone:** (901) 484-0837

## Contact information

- **Practice address:** 2042 LASCASSAS PIKE STE A4, MURFREESBORO, TN 37130-2034
- **Practice address phone:** (901) 484-0837
- **Mailing address:** 2042 LASCASSAS PIKE STE A4, MURFREESBORO, TN 37130-2034

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QA0505X | Adult Medicine Physician | — | NULL | Yes |
| 207QA0505X | Adult Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/01/2022
- **Last updated:** 08/01/2022