Provider Demographics
NPI:1487052668
Name:CUMBERLAND PODIATRIC SURGEONS INC
Entity type:Organization
Organization Name:CUMBERLAND PODIATRIC SURGEONS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HAVERLY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:931-787-1170
Mailing Address - Street 1:PO BOX 914
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38557-0914
Mailing Address - Country:US
Mailing Address - Phone:931-787-1170
Mailing Address - Fax:931-210-5745
Practice Address - Street 1:3106 MILLER AVE STE 102
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-6217
Practice Address - Country:US
Practice Address - Phone:931-787-1170
Practice Address - Fax:931-710-5983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-19
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM0379213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNT92438Medicare UPIN