Organization
AMG-CROCKETT, LLC
Active
Other names
Womens Health Clinic
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 200, LAWRENCEBURG, TN 38464-4061
(931) 766-4560
Mailing address
PO BOX 248, LAWRENCEBURG, TN 38464-0248
(931) 766-4560
Taxonomy
Speciality
Code
Description
License number
State
207VX0000X
Obstetrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1527089
—
TN
Enumeration date
02/14/2012
Last updated
07/10/2012
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