Healthcare Provider Details

I. General information

NPI: 1043469547
Provider Name (Legal Business Name): DONNELL CUSHMAN BSRT, RRT, AE-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2008
Last Update Date: 09/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 BURTON DR
FRANKLIN TN
37067-5008
US

IV. Provider business mailing address

PO BOX 17062
NASHVILLE TN
37217-0062
US

V. Phone/Fax

Practice location:
  • Phone: 615-599-7278
  • Fax: 615-591-4024
Mailing address:
  • Phone: 615-599-7278
  • Fax: 615-591-4024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279G1100X
TaxonomyGeneral Care Registered Respiratory Therapist
License NumberRRT0000000405
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: