| Amg-crockett, Llc | |
|
1605 S Locust Ave Suite 103 Lawrenceburg TN 38464-4053 | |
| (931) 762-6571 | |
| (931) 766-3339 |
| Full Name | Amg-crockett, Llc |
|---|---|
| Speciality | Psychiatry & Neurology - Neurology |
| Location | 1605 S Locust Ave, Lawrenceburg, Tennessee |
| Authorized Official Name and Position | Jone Koford (DIVISION PRESIDENT) |
| Authorized Official Contact | 6153728503 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Amg-crockett, Llc Po Box E Lawrenceburg TN 38464-0136 Ph: (931) 766-3637 | Amg-crockett, Llc 1605 S Locust Ave Suite 103 Lawrenceburg TN 38464-4053 Ph: (931) 762-6571 |
| NPI Number | 1912125600 |
|---|---|
| Provider Enumeration Date | 04/20/2007 |
| Last Update Date | 05/18/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912125600 | NPI | - | NPPES |
| 01069597 | Other | TN | AMERIGROUP |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| 208800000X | Urology | D0042141 (Maryland) | Secondary |
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