Organization
PULMONARY MEDICINE CLINIC OF JACKSON, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LARRY W CARRUTH M.D. (PRESIDENT)
(731) 664-8771
Entity
Organization
Contact information
Practice address
96 PHYSICIANS DR, JACKSON, TN 38305-2070
(731) 664-8771
(731) 660-7050
Mailing address
96 PHYSICIANS DR, JACKSON, TN 38305-2070
(731) 664-8771
(731) 660-7050
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3709887
—
TN
Enumeration date
10/25/2006
Last updated
07/21/2015
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