FAMILY CLINIC AT THE LAKE PLLC; NPI #1295620557

Contact Information

FAMILY CLINIC AT THE LAKE PLLC

1440 PICKWICK ST
SAVANNAH, TN 38372-3519

Phone: 731-925-3354
Fax: 731-438-3581
Website:

Specialty	Taxonomy Code	Specialty Code	Provider Type
Rural Health	261QR1300X	B4[14]	Rural Health Clinic
Family	363LF0000X	50	Nurse Practitioner

Indicates primary specialty

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NPI Profile & details for FAMILY CLINIC AT THE LAKE PLLC

NPI # 1295620557

LBN Legal business name FAMILY CLINIC AT THE LAKE PLLC

Authorized official ELLANIKOLE JACKSON - (OWNER)

Entity Organization

Organization subpart ¹ No

Enumeration date 06/09/2025

Last updated 06/09/2025 - About 12 months ago

Identifiers

Other

44D2112604

CLIA

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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FAMILY CLINIC AT THE LAKE PLLC

Contact Information

Specialty

Rural Health

Family

NPI Profile & details for FAMILY CLINIC AT THE LAKE PLLC

Reviews for FAMILY CLINIC AT THE LAKE PLLC