MEDICARE: CUMBERLAND HOME DOCTORS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	612	TN

General Provider Information

NPI Number	:	1740727916
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CUMBERLAND HOME DOCTORS, LLC

Provider Business Mailing Address
First Line	:	1060 GOLDEN MOUNTAIN RD
Second Line	:
City	:	SPARTA
State	:	TN
Zip	:	38583-1120
Country	:	US
Telephone Number	:	931-933-5743
Fax Number	:

Provider Business Practice Location Address
First Line	:	1060 GOLDEN MOUNTAIN RD
Second Line	:
City	:	SPARTA
State	:	TN
Zip	:	38583-1120
Country	:	US
Telephone Number	:	931-933-5743
Fax Number	:

Authorized Official
Title or Position	:	OWNER, CEO
Name	:	DR. GENETH WOLFER DO
Credential	:	D.O.
Telephone Number	:	931-933-5743

Provider Enumeration Date	:	01/26/2017
Last Update Date	:	01/26/2017

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