# AMG CROCKETT LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Southern Tennessee Primary Care
- **Organization subpart:** No

## Provider details

- **NPI number:** 1952780454
- **Authorized official:** CASEY WILLIS (MANAGER)
- **Authorized official phone:** (931) 766-4574

## Contact information

- **Practice address:** 1009 N LOCUST AVE, LAWRENCEBURG, TN 38464-2746
- **Practice address phone:** (931) 762-0531
- **Practice address fax:** (931) 762-0998
- **Mailing address:** 1009 N LOCUST AVE, LAWRENCEBURG, TN 38464-2746
- **Mailing address phone:** (931) 762-0531
- **Mailing address fax:** (931) 762-0998

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/29/2015
- **Last updated:** 05/29/2015