Provider Demographics
NPI:1134211493
Name:CULLMAN MEDICAL AND PEDIATRIC ASSOCIATES
Entity type:Organization
Organization Name:CULLMAN MEDICAL AND PEDIATRIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:K
Authorized Official - Last Name:ADDISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-739-3838
Mailing Address - Street 1:1948 AL HIGHWAY 157
Mailing Address - Street 2:SUITE 330
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35058-0642
Mailing Address - Country:US
Mailing Address - Phone:256-739-3838
Mailing Address - Fax:256-739-8350
Practice Address - Street 1:1948 AL HIGHWAY 157
Practice Address - Street 2:SUITE 330
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35058-0642
Practice Address - Country:US
Practice Address - Phone:256-739-3838
Practice Address - Fax:256-739-8350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13608174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty