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General NPI Number Information
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NPI Number | 1104964576
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Entity Type | Organization
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Legal Business Name | CUMBERLAND PEDIATRIC ASSOCIATES PC
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 03/16/2025
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Provider Practice Location Address
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Address Line | 1029 W MAIN ST SUITE M
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City | LEBANON
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State | TN
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Zip | 37087-3351
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Country | US
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Telephone | 615-453-1252
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Fax | 615-453-1286
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Provider Business Mailing Address
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Address Line | 1029 W MAIN ST SUITE M
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City | LEBANON
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State | TN
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Zip | 37087-3351
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Country | US
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Telephone | 615-453-1252
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Fax | 615-453-1286
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Authorized Official
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Title or Position | PHYSICIAN
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Name | CHARLES ANDREW JORDAN
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Credential | MD
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Telephone | 615-453-1252
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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