Healthcare Provider Details

I. General information

NPI: 1316152994
Provider Name (Legal Business Name): CUMBERLAND HEALTHCARE GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 08/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 UNIVERSITY AVE.
SEWANEE TN
37375
US

IV. Provider business mailing address

515 CUMBERLAND ST W
COWAN TN
37318-3107
US

V. Phone/Fax

Practice location:
  • Phone: 931-598-5648
  • Fax: 931-598-0778
Mailing address:
  • Phone: 931-598-5648
  • Fax: 931-598-0778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARY JANE TATE
Title or Position: ADMINSTRATOR
Credential:
Phone: 931-598-5648