Organization
PINELAKE PHYSICIAN PRACTICE, LLC
Active
Other names
Jackson Purchase Podiatry
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLOTTE LAWRENCE (SECRETARY)
(615) 920-7000
Entity
Organization
Contact information
Practice address
1029 MEDICAL CENTER CIR, MAYFIELD, KY 42066-1189
(270) 251-4590
(270) 251-4591
Mailing address
330 SEVEN SPRINGS WAY, ATTEN PROVIDER ENROLLMENT, BRENTWOOD, TN 37027-5098
(615) 920-7000
(615) 920-8775
Taxonomy
Speciality
Code
Description
License number
State
163WL0100X
Lactation Consultant (Registered Nurse)
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
207YS0123X
Facial Plastic Surgery Physician
—
—
2084N0400X
Neurology Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
—
208600000X
Surgery Physician
—
—
2086S0129X
Vascular Surgery Physician
—
—
213ES0103X
Foot & Ankle Surgery Podiatrist
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Enumeration date
11/13/2006
Last updated
01/07/2026
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