Amg-Southern Tennessee LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

AMG-SOUTHERN TENNESSEE LLC

Doing business as

Family Physicians of Estill Springs

Practice address

300 S Main St
Estill Springs, TN 37330-4042

Phone

(931) 649-5139

Fax

(931) 649-2766

NPI assigned

Feb 17, 2015

Last updated

Mar 30, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Terrance Dillon

Title

Assistant Secretary

Phone

(502) 596-7220

Specialties & licenses 1

Addresses

Other names 1

• Family Physicians of Estill Springs Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1424131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648598400000",
    "number": "1780075333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 399",
            "city": "WINCHESTER",
            "state": "TN",
            "postal_code": "373980399",
            "telephone_number": "931-649-5139",
            "fax_number": "931-649-2766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 S MAIN ST",
            "city": "ESTILL SPRINGS",
            "state": "TN",
            "postal_code": "373304042",
            "telephone_number": "931-649-5139",
            "fax_number": "931-649-2766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMG-SOUTHERN TENNESSEE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-17",
        "last_updated": "2022-03-30",
        "certification_date": "2022-03-30",
        "status": "A",
        "authorized_official_last_name": "DILLON",
        "authorized_official_first_name": "TERRANCE",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY",
        "authorized_official_telephone_number": "502-596-7220"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Physicians of Estill Springs",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Family Physicians of Estill Springs",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Walter J Boyanton III, MD
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• Family Medicine Physician in Estill Springs, TN
• Providers in Estill Springs, TN by specialty
• Family Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.