Organization
PINELAKE PHYSICIAN PRACTICE, LLC
Active
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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