Provider Demographics
NPI:1467598870
Name:TENNESSEE PHYSICIANS ALLIANCE PC
Entity Type:Organization
Organization Name:TENNESSEE PHYSICIANS ALLIANCE PC
Other - Org Name:CUMBERLAND FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:COURET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-824-4244
Mailing Address - Street 1:264 NEW SHACKLE ISLAND RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-2481
Mailing Address - Country:US
Mailing Address - Phone:615-824-4244
Mailing Address - Fax:
Practice Address - Street 1:264 NEW SHACKLE ISLAND RD
Practice Address - Street 2:SUITE 107
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-2481
Practice Address - Country:US
Practice Address - Phone:615-824-4244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 363LF0000X
TN16446207Q00000X
TN26907207R00000X
TNAPN0000007711363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ026731Medicaid