Provider Demographics
NPI:1063418663
Name:CUNNINGHAM PATHOLOGY, LLC
Entity type:Organization
Organization Name:CUNNINGHAM PATHOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-591-7999
Mailing Address - Street 1:809 UNIVERSITY BLVD E
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-2029
Mailing Address - Country:US
Mailing Address - Phone:205-759-7484
Mailing Address - Fax:205-750-5224
Practice Address - Street 1:902 DR EDWARD HILLARD DR
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-2083
Practice Address - Country:US
Practice Address - Phone:205-759-7484
Practice Address - Fax:205-750-5224
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CUNNINGHAM PATHOLOGY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-28
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL09953207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty