# COOKEVILLE HOSPITALIST GROUP, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1467133371
- **Authorized official:** KIM LARSEN (DIRECTOR OF CREDENTIALING)
- **Authorized official phone:** (770) 874-5400

## Contact information

- **Practice address:** 1 MEDICAL CENTER BLVD, COOKEVILLE, TN 38501-4294
- **Practice address phone:** (931) 528-2541
- **Mailing address:** PO BOX 36426, BELFAST, ME 04915-1206
- **Mailing address phone:** (770) 874-5400

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208M00000X | Hospitalist Physician | — | NULL | Yes |
| 208M00000X | Hospitalist Physician | — | — | Yes |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |

## Other

- **Enumeration date:** 07/25/2023
- **Last updated:** 08/13/2026