# AMG-CROCKETT, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Southern Tennessee Internal Medicine - Lawrenceburg
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417739640
- **Authorized official:** CHARLOTTE LAWRENCE (SECRETARY)
- **Authorized official phone:** (615) 920-7000

## Contact information

- **Practice address:** 184 PROSSER RD, LAWRENCEBURG, TN 38464-4233
- **Practice address phone:** (931) 762-5115
- **Mailing address:** 330 SEVEN SPRINGS WAY, BRENTWOOD, TN 37027-5098
- **Mailing address phone:** (615) 920-7000
- **Mailing address fax:** (615) 920-8775

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 10/23/2023
- **Last updated:** 09/12/2024