Healthcare Provider Details

I. General information

NPI: 1780877035
Provider Name (Legal Business Name): CANEY FORK RADIOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 08/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SIGNATURE PL
LEBANON TN
37087-3281
US

IV. Provider business mailing address

PO BOX 5000
LEBANON TN
37088-5000
US

V. Phone/Fax

Practice location:
  • Phone: 615-444-2320
  • Fax: 615-449-3163
Mailing address:
  • Phone: 615-444-2320
  • Fax: 615-449-3163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: LLOYD CAUDILL
Title or Position: DIRECTOR/ MEDICAL DOCTOR
Credential: M.D.
Phone: 615-444-2320