Organization
PINELAKE PHYSICIAN PRACTICE, LLC
Active
Other names
Jackson Purchase Primary Care - Fulton Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
SHARLEE LEBLEU (SR DIRECTOR, PROVIDER ENROLLMENT)
(615) 920-7192
Entity
Organization
Contact information
Practice address
101 MAIN ST, FULTON, KY 42041-1601
(270) 472-5245
(270) 472-5249
Mailing address
330 SEVEN SPRINGS WAY, BRENTWOOD, TN 37027-5098
(615) 920-7000
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Enumeration date
01/14/2019
Last updated
06/11/2019
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