| Amen Clinic Pc | |
|
150 Murray Guard Dr Jackson TN 38305 | |
| (731) 300-3168 | |
| (731) 300-3169 |
| Full Name | Amen Clinic Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 150 Murray Guard Dr, Jackson, Tennessee |
| Authorized Official Name and Position | Ezekiel O Adetunji (OWNER) |
| Authorized Official Contact | 7313003168 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Amen Clinic Pc Po Box 12485 Jackson TN 38308-0143 Ph: (731) 300-3168 | Amen Clinic Pc 150 Murray Guard Dr Jackson TN 38305 Ph: (731) 300-3168 |
| NPI Number | 1407121551 |
|---|---|
| Provider Enumeration Date | 03/21/2012 |
| Last Update Date | 06/27/2018 |
| Medicare PECOS PAC ID | 3971765421 |
|---|---|
| Medicare Enrollment ID | O20120430000724 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407121551 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Lisa K Medlin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073587283 PECOS PAC ID: 8224045596 Enrollment ID: I20060310000327 |
| Provider Name | Ezekiel O Adetunji |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1033302013 PECOS PAC ID: 4789743469 Enrollment ID: I20081110000810 |
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