| West Tennessee Medical Group Ut Medicine | |
|
294 Summar Dr Jackson TN 38301-3915 | |
| (731) 423-1932 | |
| (731) 660-8739 |
| Full Name | West Tennessee Medical Group Ut Medicine |
|---|---|
| Speciality | Family Medicine |
| Location | 294 Summar Dr, Jackson, Tennessee |
| Authorized Official Name and Position | Bartley Teague (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 7315121277 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| West Tennessee Medical Group Ut Medicine 1804 Highway 45 Byp Ste 604 Jackson TN 38305-4403 Ph: (731) 660-8759 | West Tennessee Medical Group Ut Medicine 294 Summar Dr Jackson TN 38301-3915 Ph: (731) 423-1932 |
| NPI Number | 1023572344 |
|---|---|
| Provider Enumeration Date | 01/31/2019 |
| Last Update Date | 02/21/2019 |
| Medicare PECOS PAC ID | 3779824719 |
|---|---|
| Medicare Enrollment ID | O20190401001719 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023572344 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 207V00000X | Obstetrics & Gynecology | (* (Not Available)) | Secondary |
| Provider Name | Ira K Ellis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922005388 PECOS PAC ID: 5496734766 Enrollment ID: I20040719001453 |
| Provider Name | Scott M Sadler |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760472906 PECOS PAC ID: 0042269383 Enrollment ID: I20050113000718 |
| Provider Name | John W Emberson |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1598758914 PECOS PAC ID: 8426092594 Enrollment ID: I20050803000128 |
| Provider Name | Armie W Walker |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1780626762 PECOS PAC ID: 2466451828 Enrollment ID: I20061212000400 |
| Provider Name | David L Maness |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1093705576 PECOS PAC ID: 4587757794 Enrollment ID: I20070904000648 |
| Provider Name | Elliott Roberts |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1225091614 PECOS PAC ID: 7315915204 Enrollment ID: I20080721000013 |
| Provider Name | Glynn M Wittber |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1720056278 PECOS PAC ID: 5294808424 Enrollment ID: I20080722000452 |
| Provider Name | Beth A Choby |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1023090685 PECOS PAC ID: 1153311873 Enrollment ID: I20080908000590 |
| Provider Name | Gregg E Mitchell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871596973 PECOS PAC ID: 4981738960 Enrollment ID: I20100812000339 |
| Provider Name | Jean Paul Gray |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1801881438 PECOS PAC ID: 3870550197 Enrollment ID: I20100915000709 |
| Provider Name | James D King |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1144256157 PECOS PAC ID: 1355447061 Enrollment ID: I20101012000398 |
| Provider Name | Ruth E Baker |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1104923598 PECOS PAC ID: 1850375197 Enrollment ID: I20101029001046 |
| Provider Name | David J Watlington |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1245209600 PECOS PAC ID: 7618156613 Enrollment ID: I20110124000299 |
| Provider Name | Staci Thomas |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1356633721 PECOS PAC ID: 5698951739 Enrollment ID: I20110525000450 |
| Provider Name | Leila Nichols |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1104159904 PECOS PAC ID: 0345412748 Enrollment ID: I20111006000768 |
| Provider Name | Tarebiye Pela |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1922241801 PECOS PAC ID: 7012165830 Enrollment ID: I20120919000429 |
| Provider Name | Michael J Martin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1013220292 PECOS PAC ID: 2365356532 Enrollment ID: I20130716000044 |
| Provider Name | Ceylon M Rowland |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1184768384 PECOS PAC ID: 6406940048 Enrollment ID: I20140604001722 |
| Provider Name | Robin D Atkinson |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1154613792 PECOS PAC ID: 2961624846 Enrollment ID: I20141107002081 |
| Provider Name | Ashley Leaphart |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1306927025 PECOS PAC ID: 2860547981 Enrollment ID: I20141119001148 |
| Provider Name | Grant Kneeland Studebaker |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1265774236 PECOS PAC ID: 0244479392 Enrollment ID: I20160831001947 |
| Provider Name | Christopher M Knight |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1790102069 PECOS PAC ID: 5698994150 Enrollment ID: I20170629003015 |
| Provider Name | Adewale Odukoya |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1902268550 PECOS PAC ID: 1456643345 Enrollment ID: I20180612001769 |
| Provider Name | Steven Tyler Brown |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1972921096 PECOS PAC ID: 4981910262 Enrollment ID: I20180814001063 |
| Provider Name | Melissa A Mooney |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1386030914 PECOS PAC ID: 4486904448 Enrollment ID: I20180912002343 |
| Provider Name | Johnny Lee Mayes |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1912298985 PECOS PAC ID: 0648490797 Enrollment ID: I20181111000004 |
| Provider Name | Joshua D Stevens |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1780979930 PECOS PAC ID: 7911144985 Enrollment ID: I20181112000115 |
| Provider Name | Justin R Turner |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1235670647 PECOS PAC ID: 2365712627 Enrollment ID: I20181220002834 |
| Provider Name | Shandeidra N Bonds-singleton |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1528477007 PECOS PAC ID: 8325386006 Enrollment ID: I20190205003636 |
| Provider Name | Rosalyn Patrice Porter |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1396075537 PECOS PAC ID: 1557536521 Enrollment ID: I20190912002238 |
| Provider Name | Joshua L Fainsod |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1427407006 PECOS PAC ID: 1557657806 Enrollment ID: I20190912003065 |
| Provider Name | Devan Rae Trull |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952702995 PECOS PAC ID: 2163717489 Enrollment ID: I20191119000033 |
| Provider Name | Brandon S Churchill |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1649774209 PECOS PAC ID: 9830449644 Enrollment ID: I20200402002645 |
| Provider Name | Ashley Laurel Self |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1518314269 PECOS PAC ID: 0547553042 Enrollment ID: I20200728004030 |
| Provider Name | Heidi Hill |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528698594 PECOS PAC ID: 4789000514 Enrollment ID: I20200811002977 |
| Provider Name | Bader Nizar Kashlan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1336680560 PECOS PAC ID: 1658642236 Enrollment ID: I20200819000733 |
| Provider Name | Shivani Bhatnagar |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1821529546 PECOS PAC ID: 7911323969 Enrollment ID: I20200820002317 |
| Provider Name | Maureen Foster |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1841563285 PECOS PAC ID: 0244470094 Enrollment ID: I20210112000676 |
| Provider Name | Von-nica W Johnson |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1811269962 PECOS PAC ID: 2769641471 Enrollment ID: I20210217002898 |
| Provider Name | Joshua D Downey |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1255893699 PECOS PAC ID: 7719213990 Enrollment ID: I20210716001557 |
| Provider Name | Erica Pahua |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1851731269 PECOS PAC ID: 0143537811 Enrollment ID: I20211008001087 |
| Provider Name | Glynn Alan Riels |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811525017 PECOS PAC ID: 6103249784 Enrollment ID: I20211206002648 |
| Provider Name | Victoria S Watson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396373510 PECOS PAC ID: 6901220268 Enrollment ID: I20220406001064 |
| Provider Name | Caitlyn R Trostel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346878568 PECOS PAC ID: 1153745674 Enrollment ID: I20220411002047 |
| Provider Name | Bradley Mcmillen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1962030163 PECOS PAC ID: 8325462690 Enrollment ID: I20220420000555 |
| Provider Name | Maria D Marshel |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1811458623 PECOS PAC ID: 5395163356 Enrollment ID: I20220608002333 |
| Provider Name | Zachary T Meyer |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1831659903 PECOS PAC ID: 0345577888 Enrollment ID: I20220804002709 |
| Provider Name | Mark Wendolowski |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396206371 PECOS PAC ID: 9133461940 Enrollment ID: I20220808000380 |
| Provider Name | Garrett Risley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1598328858 PECOS PAC ID: 9931441409 Enrollment ID: I20220831002907 |
| Provider Name | Angela T Cheriyan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1851953657 PECOS PAC ID: 6103156161 Enrollment ID: I20220907003848 |
| Provider Name | Christopher J Bauer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679101869 PECOS PAC ID: 4880017466 Enrollment ID: I20230511000144 |
| Provider Name | Tiffany D Williams |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1942444138 PECOS PAC ID: 9335507318 Enrollment ID: I20230623000498 |
| Provider Name | Tawsif M Nadir |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1023637352 PECOS PAC ID: 8325465248 Enrollment ID: I20230727000771 |
| Provider Name | Danny J Montenegro |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1780209049 PECOS PAC ID: 8123442837 Enrollment ID: I20230803000663 |
| Provider Name | Jessica Coleman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1700400355 PECOS PAC ID: 7214351006 Enrollment ID: I20230914001945 |
| Provider Name | Thomas Sanders |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1790313906 PECOS PAC ID: 5496179764 Enrollment ID: I20230918000786 |
| Provider Name | Christopher Reyes Caangay |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1063032969 PECOS PAC ID: 6901237262 Enrollment ID: I20230925003780 |
Therapy & Learning Center Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 32 Garland Dr, Jackson, TN 38305 Phone: 731-668-3322 Fax: 731-664-2491 | |
Wellness Clinic And Family Care Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 21 Meridian Springs Dr, Jackson, TN 38301 Phone: 731-256-0526 Fax: 731-256-1720 | |
Ultimate Health Clinic North Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 16 Murray Guard Dr Ste B, Jackson, TN 38305 Phone: 731-660-0887 Fax: 731-660-9996 | |
The Medical Clinic Of Jackson Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 587 Skyline Dr, Jackson, TN 38301 Phone: 731-424-8922 Fax: 731-423-2922 | |
West Tennessee Medical Group Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 620 Skyline Dr, Jackson, TN 38301 Phone: 731-660-8730 Fax: 731-660-8739 | |
Northside Medical Clinic, P.c. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 31 Hughes Dr, Jackson, TN 38305 Phone: 731-668-2800 Fax: 731-668-6161 |