Healthcare Provider Details

I. General information

NPI: 1700492220
Provider Name (Legal Business Name): COMMONWEALTH HEALTH CORPORATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2020
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 BROOKHAVEN RD STE 103
FRANKLIN KY
42134-2746
US

IV. Provider business mailing address

PO BOX 117914
ATLANTA GA
30368-7914
US

V. Phone/Fax

Practice location:
  • Phone: 270-598-4878
  • Fax: 270-598-4875
Mailing address:
  • Phone: 270-598-4878
  • Fax: 270-598-4875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MICHELE W LAWLESS
Title or Position: EXECUTIVE VICE PRESIDENT & CFO
Credential:
Phone: 270-745-1500