Organization
PINELAKE PHYSICIAN PRACTICE LLC
Active
Other names
Jackson Purchase Primary Care Hussain Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY TEAGUE (SECRETARY)
(615) 920-7000
Entity
Organization
Contact information
Practice address
417 S 6TH ST, MAYFIELD, KY 42066-2311
(270) 247-1104
Mailing address
330 SEVEN SPRINGS WAY, BRENTWOOD, TN 37027-5098
(615) 920-7000
(915) 920-8775
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Enumeration date
11/15/2019
Last updated
11/15/2019
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