Healthcare Provider Details

I. General information

NPI: 1518447622
Provider Name (Legal Business Name): CULLMAN REGIONAL MEDICAL CENTER PHYSICIAN GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2018
Last Update Date: 08/17/2018
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

P.O. BOX 1108
CULLMAN AL
35056-1108
US

V. Phone/Fax

Practice location:
  • Phone: 256-735-5041
  • Fax: 256-737-2050
Mailing address:
  • Phone: 256-737-2081
  • Fax: 256-737-2050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. NESHA DONALDSON
Title or Position: CFO
Credential:
Phone: 256-737-2598