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WILLOW MEDICAL CLINIC, LLC
NPI 1356507404
Physician Assistant - Medical in Manchester, TN

Active since July 29, 2008CLIA 44D2323724 · Waiver
1400 WILLOW DR, MANCHESTER, TN 37355(931) 728-7677(931) 728-7066 Get Directions Write a Review

NPPES record last updated: July 29, 2008. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Willow Medical Clinic, Llc NPPES

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

WILLOW MEDICAL CLINIC, LLC (NPI 1356507404) is a healthcare organization registered as a medical in Manchester, Tennessee and active in the NPI registry since July 2008. The organization holds a CLIA Waiver certificate valid through May 12, 2027 and lists Tammy Shelley, Office Manager/assist. Business Adm, as its authorized official.

NPPES Registry Identity

NPI1356507404
Entity TypeOrganization
Primary Taxonomy363AM0700X
Legal Business NameWILLOW MEDICAL CLINIC, LLC
Location Address1400 WILLOW DRManchester, TN 37355-2438
Mailing AddressPo Box 1223Manchester, TN 37349-1223
Phone(931) 728-7677
Fax(931) 728-7066
Organization SubpartNo
Authorized OfficialTammy ShelleyOffice Manager/assist. Business Adm · (931) 570-4755
Enumeration DateJuly 29, 2008
✔ NPI 1356507404 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AM0700X
Also ListedNurse Practitioner · FamilyTaxonomy 363LF0000X
1400 WILLOW DR, Manchester, TN 37355
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

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 44D2323724

Willow Pediatric Clinic, LLC · Manchester, TN
Active · expires May 12, 2027
CLIA Number44D2323724
Laboratory TypePhysician Office
Certificate Effective DateMay 13, 2025
Certificate Expiration DateMay 12, 2027
Laboratory DirectorRebecca D. Swiger
Laboratory Phone(931) 450-1486
Laboratory LocationWillow Pediatric Clinic, LLC1400 Willow Dr, Manchester, TN 37355
CLIA data matches this NPI record on: Address
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

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

WILLOW PEDIATRIC CLINIC, LLC
Clinic/Center (Primary Care)
1400 WILLOW DR
MANCHESTER, TN 37355
Coffee County (931) 273-5685
REBECCA DIANE SWIGER DNP-FNP-C
Nurse Practitioner (Family)
1400 WILLOW DR
MANCHESTER, TN 37355
Coffee County (314) 501-4869

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 Willow Medical Clinic, LLC's NPI number?

The NPI number for Willow Medical Clinic, LLC is 1356507404. It was assigned to this organization in the NPPES registry on July 29, 2008.

Where is Willow Medical Clinic, LLC located?

Willow Medical Clinic, LLC is located at 1400 Willow Dr, Manchester, TN 37355. The listed phone number is (931) 728-7677.

What is Willow Medical Clinic, LLC's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Does Willow Medical Clinic, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 44D2323724) is associated with this NPI, valid through May 12, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Willow Medical Clinic, LLC was last updated on July 29, 2008. NPI Profile syncs with the weekly NPPES data releases published by CMS.