Active NPI
Antuan Eugenia Cornelius
- Contractor
- Clarksville, TN
National Provider Identifier
1306302021
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Contractor
- License
- 23765
- Practice address
- 813 Peachers Mill Rd
Clarksville, TN 37042-5419 - Phone
- (931) 302-4500
- NPI assigned
- Feb 18, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | 23765 | TN | Primary |
Addresses
Primary practice location
813 Peachers Mill Rd
Clarksville, TN 37042-5419
Mailing address
813 Peachers Mill Rd
Clarksville, TN 37042-5419
Phone (931) 302-4500
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 62-183507 | Other | TN | VA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23765 | TN | MD | Contractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1550448000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1550448000000",
"number": "1306302021",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "813 PEACHERS MILL RD",
"city": "CLARKSVILLE",
"state": "TN",
"postal_code": "370425419",
"telephone_number": "931-302-4500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "813 PEACHERS MILL RD",
"city": "CLARKSVILLE",
"state": "TN",
"postal_code": "370425419",
"telephone_number": "931-302-4500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CORNELIUS",
"first_name": "ANTUAN",
"middle_name": "EUGENIA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-02-18",
"last_updated": "2019-02-18",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": "TN",
"license": "23765",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VA",
"identifier": "62-183507",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Clarksville, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.