| Lake County Internal Medicine Clinic | |
|
305 E Tickle St Dyersburg TN 38024-3117 | |
| (731) 285-2324 | |
| (731) 660-8739 |
| Full Name | Lake County Internal Medicine Clinic |
|---|---|
| Speciality | Internal Medicine |
| Location | 305 E Tickle St, Dyersburg, Tennessee |
| Authorized Official Name and Position | Daniel P Green (OWNER DIRECTOR) |
| Authorized Official Contact | 7312852324 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake County Internal Medicine Clinic 1804 Highway 45 Byp Suite 604 Jackson TN 38305-4436 Ph: (731) 660-8759 | Lake County Internal Medicine Clinic 305 E Tickle St Dyersburg TN 38024-3117 Ph: (731) 285-2324 |
| NPI Number | 1598834087 |
|---|---|
| Provider Enumeration Date | 11/07/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598834087 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 5993 (Tennessee) | Primary |
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