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General NPI Number Information
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NPI Number | 1558632091
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Entity Type | Organization
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Legal Business Name | COOKEVILLE UROLOGY, PLLC
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Dates
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Enumeration Date | 01/13/2012
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Last Update Date | 01/13/2012
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Provider Practice Location Address
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Address Line | 254 W 7TH ST
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City | COOKEVILLE
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State | TN
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Zip | 38501-1719
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Country | US
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Telephone | 931-520-6270
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Fax |
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Provider Business Mailing Address
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Address Line | 254 W 7TH ST
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City | COOKEVILLE
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State | TN
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Zip | 38501-1719
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Country | US
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Telephone | 931-520-6270
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. TIMOTHY R COLLINS
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Credential | MD
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Telephone | 931-520-6270
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | MD24831
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License Number State | TN
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