# MCKENZIE MEDICAL CENTER PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Hometown Health Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1477516953
- **Authorized official:** TAMMY ETHERIDGE (CHIEF OPERATING OFFICER)
- **Authorized official phone:** (731) 352-7907

## Contact information

- **Practice address:** 205A HOSPITAL DR, MC KENZIE, TN 38201-1649
- **Practice address phone:** (731) 352-7907
- **Practice address fax:** (833) 690-3848
- **Mailing address:** 205A HOSPITAL DR, MC KENZIE, TN 38201-1649
- **Mailing address phone:** (731) 352-7907
- **Mailing address fax:** (833) 690-3848

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | LSW5620 | TN | — |
| 106H00000X | Marriage & Family Therapist | LMFT917 | TN | — |
| 152W00000X | Optometrist | ODT441 | TN | — |
| 207R00000X | Internal Medicine Physician | MD15682 | TN | — |
| 208000000X | Pediatrics Physician | MD46412 | TN | — |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | Yes |
| 363A00000X | Physician Assistant | PA1503 | TN | — |
| 363LF0000X | Family Nurse Practitioner | APN6244 | TN | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 04/07/2006
- **Last updated:** 12/03/2024