Healthcare Provider Details

I. General information

NPI: 1962510529
Provider Name (Legal Business Name): CUMBERLAND RADIOLOGY GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 03/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 S MAIN ST
CROSSVILLE TN
38555-5048
US

IV. Provider business mailing address

PO BOX 3139
CROSSVILLE TN
38557-3139
US

V. Phone/Fax

Practice location:
  • Phone: 931-484-9511
  • Fax:
Mailing address:
  • Phone: 931-484-0048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES STALLWORTH
Title or Position: PRESIDENT
Credential:
Phone: 931-484-0048