Provider Demographics
NPI:1750670766
Name:CANNON COUNTY HOSPITAL LLC
Entity Type:Organization
Organization Name:CANNON COUNTY HOSPITAL LLC
Other - Org Name:STONES RIVER FAMILY & URGENT CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:O
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-563-7207
Mailing Address - Street 1:324 DOOLITTLE RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:TN
Mailing Address - Zip Code:37190-1139
Mailing Address - Country:US
Mailing Address - Phone:615-563-7201
Mailing Address - Fax:615-563-7314
Practice Address - Street 1:370 DOOLITTLE RD STE 1
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:TN
Practice Address - Zip Code:37190-1129
Practice Address - Country:US
Practice Address - Phone:615-563-7275
Practice Address - Fax:615-563-7333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-30
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000015595363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty