Healthcare Provider Details

I. General information

NPI: 1184754111
Provider Name (Legal Business Name): CUMBERLAND FAMILY CARE P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 COLLEGE ST
SPENCER TN
38585-3436
US

IV. Provider business mailing address

457 VISTA DR
SPARTA TN
38583-1360
US

V. Phone/Fax

Practice location:
  • Phone: 931-946-2113
  • Fax: 931-946-2248
Mailing address:
  • Phone: 931-738-3383
  • Fax: 931-738-8911

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: MISCHELLE L FERRELL
Title or Position: PRACTICE ADMINISTRATOR
Credential: MHA
Phone: 931-738-3383