Provider Demographics
NPI:1740727916
Name:CUMBERLAND HOME DOCTORS, LLC
Entity type:Organization
Organization Name:CUMBERLAND HOME DOCTORS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GENETH
Authorized Official - Middle Name:WOLFER
Authorized Official - Last Name:DO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:931-933-5743
Mailing Address - Street 1:1060 GOLDEN MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:TN
Mailing Address - Zip Code:38583-1120
Mailing Address - Country:US
Mailing Address - Phone:931-933-5743
Mailing Address - Fax:
Practice Address - Street 1:1060 GOLDEN MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:TN
Practice Address - Zip Code:38583-1120
Practice Address - Country:US
Practice Address - Phone:931-933-5743
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CUMBERLAND HOME DOCTORS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN612261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center