Organization
PROXIMA CENTAURI, PLLC
Active
Other names
Lincoln Tree Medical Clinic of Tullahoma, PLLC
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES EDWARDS ROTH MD (PRESIDENT)
(931) 723-7950
Entity
Organization
Contact information
Practice address
1600 MCARTHUR ST, MANCHESTER, TN 37355-2522
(931) 723-7950
(931) 723-7950
Mailing address
PO BOX 437, MANCHESTER, TN 37349-0437
(931) 723-7950
(931) 723-7815
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
—
—
261QP3300X
Pain Clinic/Center
Primary
—
—
363AM0700X
Medical Physician Assistant
—
—
Other
Enumeration date
12/07/2011
Last updated
10/31/2012
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