Healthcare Provider Details

I. General information

NPI: 1154338788
Provider Name (Legal Business Name): CULLMAN PROFESSIONAL RESOURCES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 GOLFVIEW DR NE
ARAB AL
35016-5473
US

IV. Provider business mailing address

131 GOLFVIEW DR NE
ARAB AL
35016-5473
US

V. Phone/Fax

Practice location:
  • Phone: 256-931-2307
  • Fax:
Mailing address:
  • Phone: 256-931-2307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberDO575
License Number StateAL

VIII. Authorized Official

Name: NICHOLAS T MANSUETTA
Title or Position: OWNER
Credential: D.O.
Phone: 256-931-2307