Provider Demographics
NPI:1922138247
Name:CUMBERLAND SKIN SURGERY AND DERMATOLOGY
Entity Type:Organization
Organization Name:CUMBERLAND SKIN SURGERY AND DERMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:COUNTESS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-449-5255
Mailing Address - Street 1:PO BOX 1172
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37088-1172
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1405 W BADDOUR PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-2567
Practice Address - Country:US
Practice Address - Phone:615-449-5255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41873261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty