Organization
AMG-CROCKETT, LLC
Active
Other names
ADVANCED NEUROLOGY ASSOCIATES
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL CLARK (DIVISION PRESIDENT)
(615) 372-8500
Entity
Organization
Contact information
Practice address
1605 S LOCUST AVE, SUITE 103, LAWRENCEBURG, TN 38464-4053
(931) 762-6571
(931) 762-3339
Mailing address
PO BOX 248, LAWRENCEBURG, TN 38464-0248
(931) 762-6571
(931) 762-3339
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
38839
TN
Other
Enumeration date
07/22/2008
Last updated
05/29/2012
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