Organization
ADVANCED MEDICAL GROUP
Active
Other names
Foothills Pain Management
Organization subpart
No
Provider details
NPI number
Authorized official
TERRY BRAGG DC (PRESIDENT)
(865) 982-7802
Entity
Organization
Contact information
Practice address
717 WATKINS RD, MARYVILLE, TN 37801-4598
(865) 980-7802
(865) 980-7804
Mailing address
615 LEEPER PKWY, LENOIR CITY, TN 37772-6151
(865) 986-8600
(865) 986-0961
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
0682
TN
363LA2200X
Adult Health Nurse Practitioner
0000013567
TN
363LA2200X
Adult Health Nurse Practitioner
000011720
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1510839
—
TN
Enumeration date
01/26/2010
Last updated
01/26/2010
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