Organization
CROSSVILLE MEDICAL GROUP PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY BURTON (ADMINISTRATOR)
(931) 484-5141
Entity
Organization
Contact information
Practice address
100 LANTANA RD, SUITE 202, CROSSVILLE, TN 38555-1903
(931) 484-5141
(931) 484-5620
Mailing address
100 LANTANA RD, SUITE 202, CROSSVILLE, TN 38555-1903
(931) 484-5141
(931) 484-5620
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3370906
—
TN
Enumeration date
09/07/2006
Last updated
11/19/2009
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