Organization
AMG -SOUTHERN TENNESSEE LLC
Active
Organization
AMG -SOUTHERN TENNESSEE LLC
Active
Parent organization
AMG-SOUTHERN TENNESSEE LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
AMG-SOUTHERN TENNESSEE LLC
Authorized official
WILLIAM GRACEY (CEO)
(615) 372-8500
Entity
Organization
Contact information
Practice address
15 S CENTRAL AVE, MONTEAGLE, TN 37356-3074
(931) 924-4045
(931) 924-4105
Mailing address
15 S CENTRAL AVE, MONTEAGLE, TN 37356-3074
(931) 924-4045
(931) 924-4105
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3716448
—
TN
Enumeration date
07/17/2006
Last updated
04/20/2008
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