Provider Demographics
NPI:1518990290
Name:CARDWELL, ALBERT (PAC)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:
Last Name:CARDWELL
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 EAST CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:LAFOLLETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37766
Mailing Address - Country:US
Mailing Address - Phone:423-907-1601
Mailing Address - Fax:423-907-1647
Practice Address - Street 1:905 E CENTER AVE
Practice Address - Street 2:
Practice Address - City:LAFOLLETTE
Practice Address - State:TN
Practice Address - Zip Code:37766
Practice Address - Country:US
Practice Address - Phone:423-907-1601
Practice Address - Fax:423-907-1647
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA27363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P89414Medicare UPIN