| Positive Living Group | |
|
39 Murray Guard Dr Jackson TN 38305-3610 | |
| (731) 267-2861 | |
| (877) 334-9483 |
| Full Name | Positive Living Group |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 39 Murray Guard Dr, Jackson, Tennessee |
| Authorized Official Name and Position | Raymond Watt (MANAGING MEMBER) |
| Authorized Official Contact | 7312672861 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Positive Living Group 40 Crest Ridge Dr Jackson TN 38305-8502 Ph: (731) 267-2861 | Positive Living Group 39 Murray Guard Dr Jackson TN 38305-3610 Ph: (731) 267-2861 |
| NPI Number | 1336614130 |
|---|---|
| Provider Enumeration Date | 10/08/2018 |
| Last Update Date | 10/26/2022 |
| Certification Date | 10/26/2022 |
| Medicare PECOS PAC ID | 8224367370 |
|---|---|
| Medicare Enrollment ID | O20190916000575 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336614130 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Twana C Miller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912248212 PECOS PAC ID: 2769623370 Enrollment ID: I20130724000558 |
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