Healthcare Provider Details

I. General information

NPI: 1689994154
Provider Name (Legal Business Name): CUMBERLAND BRAIN AND SPINE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2010
Last Update Date: 07/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1641 SCOTTSVILLE RD
BOWLING GREEN KY
42104-3244
US

IV. Provider business mailing address

5653 FRIST BLVD STE 731
HERMITAGE TN
37076-2066
US

V. Phone/Fax

Practice location:
  • Phone: 270-781-1772
  • Fax: 270-781-2212
Mailing address:
  • Phone: 270-781-1772
  • Fax: 270-781-2212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number37599
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number37636
License Number StateKY

VIII. Authorized Official

Name: CHRISTOPHER TALEGHANI
Title or Position: PRESIDENT
Credential: MD
Phone: 615-884-0001