Organization
AMG-HILLSIDE LLC
Active
Organization
AMG-HILLSIDE LLC
Active
Other names
Internal Medicine of Pulaski
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL CLARK (DIVISION PRESIDENT)
(615) 372-8500
Entity
Organization
Contact information
Practice address
1255 E COLLEGE ST, SUITE 500, PULASKI, TN 38478-4515
(931) 363-7531
Mailing address
PO BOX 1186, PULASKI, TN 38478-1186
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
45230
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1514799
—
TN
Enumeration date
08/18/2009
Last updated
10/20/2009
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