Healthcare Provider Details

I. General information

NPI: 1306079397
Provider Name (Legal Business Name): TIMOTHY DALE CUMMINS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2009
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2341 MCCALLIE AVE SUITE 402
CHATTANOOGA TN
37404-3239
US

IV. Provider business mailing address

2341 MCCALLIE AVE STE 402
CHATTANOOGA TN
37404-3231
US

V. Phone/Fax

Practice location:
  • Phone: 423-698-3309
  • Fax: 423-624-6355
Mailing address:
  • Phone: 423-698-3309
  • Fax: 423-624-6355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number14343
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: