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FAMILY MEDICAL CLINIC OF JACKSON
NPI 1215693171
Clinic/Center - Primary Care in Jackson, TN

Active since November 15, 2021CLIA 44D2185357 · Waiver
1022 GREYSTONE SQ, JACKSON, TN 38305(731) 300-2001(731) 240-8095 Get Directions Write a Review

NPPES record last updated: April 15, 2022. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Apr 15, 2022, Nov 15, 2021 (2 updates tracked since 2021).

About Family Medical Clinic Of Jackson NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

FAMILY MEDICAL CLINIC OF JACKSON (NPI 1215693171) is a healthcare organization registered as a primary care in Jackson, Tennessee and active in the NPI registry since November 2021. The organization holds a CLIA Waiver certificate valid through June 1, 2028 and lists Deborah Leggett, Owner, as its authorized official.

NPPES Registry Identity

NPI1215693171
Entity TypeOrganization
Primary Taxonomy261QP2300X
Legal Business NameFAMILY MEDICAL CLINIC OF TREZEVANT
Location Address1022 GREYSTONE SQJackson, TN 38305-3580
Mailing Address1022 Greystone SqJackson, TN 38305-3580 · (731) 300-2001 · Fax (731) 240-8095
Phone(731) 300-2001
Fax(731) 240-8095
Organization SubpartNo
Authorized OfficialDeborah LeggettOwner · (731) 300-2001
Enumeration DateNovember 15, 2021
Last NPPES UpdateApril 15, 20222 updates tracked since enumeration
NPPES CertifiedMarch 31, 2022
✔ NPI 1215693171 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Primary CareAmbulatory Health Care Facilities
Taxonomy Code261QP2300X
1022 GREYSTONE SQ, Jackson, TN 38305
Open in Google Maps ↗

Other Names 1

Other NameFamily Medical Clinic Of Jackson

Other Identifiers 1

MedicaidQ054230TN

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 44D2185357

Family Medical Clinic Of Jackson · Jackson, TN
Active · expires Jun 1, 2028
CLIA Number44D2185357
Laboratory TypePractitioner Other
Certificate Effective DateJune 2, 2026
Certificate Expiration DateJune 1, 2028
Laboratory DirectorDr. Joe Harris
Laboratory Phone(731) 300-2001
Laboratory LocationFamily Medical Clinic Of Jackson1022 Greystone Square, Jackson, TN 38305
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

HOLLY MICHELLE SANDERS NP
Nurse Practitioner (Family)
1022 GREYSTONE SQ
JACKSON, TN 38305
Madison County (731) 300-2001
MS. JUDY B. BAIN N.P.
Nurse Practitioner (Family)
1022 GREYSTONE SQ
JACKSON, TN 38305
Madison County (731) 300-2001
RHIANNON MICHELLE ANDRESEN FNP-C
Nurse Practitioner (Family)
1022 GREYSTONE SQ
JACKSON, TN 38305
Madison County (731) 300-2001
MS. ALICIA GRADEN NP-C
Nurse Practitioner (Family)
1022 GREYSTONE SQ
JACKSON, TN 38305
Madison County (731) 300-2001
MARY KATHRYN RILEY RN, FNP
Nurse Practitioner
1022 GREYSTONE SQ
JACKSON, TN 38305
Madison County (731) 300-2001

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Family Medical Clinic Of Trezevant's NPI number?

The NPI number for Family Medical Clinic Of Trezevant is 1215693171. It was assigned to this organization in the NPPES registry on November 15, 2021. The provider is also known as Family Medical Clinic Of Jackson.

Where is Family Medical Clinic Of Trezevant located?

Family Medical Clinic Of Trezevant is located at 1022 Greystone Sq, Jackson, TN 38305. The listed phone number is (731) 300-2001.

What is Family Medical Clinic Of Trezevant's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.

Does Family Medical Clinic Of Trezevant hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 44D2185357) is associated with this NPI, valid through June 1, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Family Medical Clinic Of Trezevant was last updated on April 15, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.