Provider Demographics
NPI:1780708438
Name:CARRUTH, CYNTHIA WILSON (MD)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:WILSON
Last Name:CARRUTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 WINDWOOD CV
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-8814
Mailing Address - Country:US
Mailing Address - Phone:731-664-7326
Mailing Address - Fax:731-664-7327
Practice Address - Street 1:3 WINDWOOD CV
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-8814
Practice Address - Country:US
Practice Address - Phone:731-664-7326
Practice Address - Fax:731-664-7327
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000010818174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist