Individual
ANTUAN EUGENIA CORNELIUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
813 PEACHERS MILL RD, CLARKSVILLE, TN 37042-5419
(931) 302-4500
Mailing address
813 PEACHERS MILL RD, CLARKSVILLE, TN 37042-5419
(931) 302-4500
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
23765
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
62-183507
VA
TN
Enumeration date
02/18/2019
Last updated
02/18/2019
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