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General NPI Number Information
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NPI Number | 1417996117
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Entity Type | Individual
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Provider Name | CAROL R CANTRELL M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/06/2006
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Last Update Date | 08/08/2017
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Provider Practice Location Address
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Address Line | 2304 MEMORIAL BLVD
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City | SPRINGFIELD
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State | TN
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Zip | 37172-3929
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Country | US
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Telephone | 615-384-8133
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Fax | 615-384-8199
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Provider Business Mailing Address
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Address Line | 2304 MEMORIAL BLVD
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City | SPRINGFIELD
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State | TN
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Zip | 37172-3929
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Country | US
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Telephone | 615-384-8133
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Fax | 615-384-8199
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD018063
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License Number State | TN
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