Organization
AMG-CROCKETT, LLC
Active
Other names
Lawrence County Surgical Services
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL CLARK (DIVISION PRESIDENT)
(615) 372-8500
Entity
Organization
Contact information
Practice address
1605 S LOCUST AVE, SUITE 201, LAWRENCEBURG, TN 38464-4061
(931) 766-8525
Mailing address
PO BOX 248, LAWRENCEBURG, TN 38464-0248
(931) 766-8525
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
48076
TN
Other
Enumeration date
02/14/2012
Last updated
02/17/2012
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