| Organization Name: | CUMBERLAND GAP MEDICAL |
| NPI Number: | 1336563204 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | AMANDA SUE COLLINS (NURSE PRACTITIONER) |
| Mailing Address: | 502 W Central Ave Suite 2 La Follette |
| State: | TN US |
| Postal Code: | 377663400 |
| Phone Number: | 4232019799 |
| Fax Number: | 4234378162 |
| NPI Enumeration Date: | 02/12/2014 |
| NPI Last Update Date: | 02/12/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | APN0000016605 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |