Healthcare Provider Details

I. General information

NPI: 1508959107
Provider Name (Legal Business Name): CULLMAN ONCOLOGY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/21/2022
Certification Date: 05/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 AL HIGHWAY 157
CULLMAN AL
35058
US

IV. Provider business mailing address

P.O. BOX 2126
CULLMAN AL
35055
US

V. Phone/Fax

Practice location:
  • Phone: 256-255-2500
  • Fax: 256-255-2501
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateAL

VII. Legacy identifiers

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

VIII. Authorized Official

Name: JOHNNY NACILLA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 256-255-2500