Healthcare Provider Details

I. General information

NPI: 1023642568
Provider Name (Legal Business Name): CULLMAN REGIONAL MEDICAL GROUP HOSPITALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2020
Last Update Date: 09/23/2022
Certification Date: 09/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1912 AL HIGHWAY 157
CULLMAN AL
35058-0609
US

IV. Provider business mailing address

PO BOX 2895
CULLMAN AL
35056-2895
US

V. Phone/Fax

Practice location:
  • Phone: 256-735-5071
  • Fax:
Mailing address:
  • Phone: 256-735-5071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: NESHA DONALDSON
Title or Position: COO
Credential:
Phone: 256-737-2585