| Doctor Name: | DEROK SHANE CORNWELL |
| NPI Number: | 1174591366 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA-C |
| License Number: | PA- 885 |
| Business Practice Address: | 7938 Al Highway 69 Suite 100 Guntersville, AL - 359767134 |
| Business Phone Number: | 2565718445 |
| Business Fax Number: | 2565718447 |
| Mailing Address: | 7938 Al Highway 69, Suite 100 GUNTERSVILLE |
| State: | AL |
| Postal Code: | 359767134 |
| Phone Number: | 2565718445 |
| Fax Number: | 2565718447 |
| NPI Enumeration Date: | 03/14/2006 |
| NPI Last Update Date: | 01/27/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AS0400X |
| License Number: | PA- 885 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Surgical |
| Taxonomy Definition: | |