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General NPI Number Information
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NPI Number | 1962510529
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Entity Type | Organization
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Legal Business Name | CUMBERLAND RADIOLOGY GROUP PC
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 03/16/2012
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Provider Practice Location Address
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Address Line | 421 S MAIN ST
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City | CROSSVILLE
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State | TN
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Zip | 38555-5048
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Country | US
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Telephone | 931-484-9511
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3139
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City | CROSSVILLE
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State | TN
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Zip | 38557-3139
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Country | US
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Telephone | 931-484-0048
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAMES STALLWORTH
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Credential |
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Telephone | 931-484-0048
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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