Healthcare Provider Details

I. General information

NPI: 1104138643
Provider Name (Legal Business Name): CULLMAN REGIONAL HOSPITALIST SERVICES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2010
Last Update Date: 07/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1912 AL HIGHWAY 157
CULLMAN AL
35058-0609
US

IV. Provider business mailing address

1948 AL HIGHWAY 157 SUITE 330
CULLMAN AL
35058-0642
US

V. Phone/Fax

Practice location:
  • Phone: 256-255-0228
  • Fax: 256-739-8350
Mailing address:
  • Phone: 256-255-0228
  • Fax: 256-739-8350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number17629
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-054737
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1-060971
License Number StateAL

VIII. Authorized Official

Name: DR. JOHN D MORRIS
Title or Position: OWNER
Credential: M.D.
Phone: 256-255-0228