Healthcare Provider Details

I. General information

NPI: 1679771356
Provider Name (Legal Business Name): CUMBERLAND FAMILY CARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 COLLEGE ST
SPENCER TN
38585-3214
US

IV. Provider business mailing address

457 VISTA DR
SPARTA TN
38583-1360
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. MISCHELLE L FERRELL
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 931-738-3383