EXHIBIT 3.49

CERTIFICATE OF INCORPORATION

OF

NATIONAL HEALTHCARE OF CULLMAN, INC.

1. The name of the corporation is NATIONAL HEALTHCARE OF CULLMAN, INC.

2. The address of its registered office in the State of Delaware is Corporation Trust Center, 1209 Orange Street, in the City of Wilmington, County of New Castle. The name of its registered agent at such address is The Corporation Trust Company.

3. The nature of the business or purposes to be conducted or, promoted is to engage in any lawful act or activity for which corporations may be organized under the General Corporation Law of Delaware.

4. The total number of shares of stock which the corporation shall have authority to issue is One Thousand (1,000) common and the par value of each of such shares is One Dollar ($1.00) amounting in the aggregate to One Thousand Dollars ($1,000.00).

5A. The name and mailing address of each incorporator is as follows:

D. A. Hampton
Corporation Trust Center
1209 Orange Street
Wilmington, Delaware 19801

J. A. Grodzicki
Corporation Trust Center
1209 Orange Street
Wilmington, Delaware 19801

S. J. Queppet
Corporation Trust Center
1209 Orange Street
Wilmington, Delaware 19801

5B. The name and mailing address of each person, who is to serve as a director until the first annual meeting of the stockholders or until a successor is elected and qualified, is as follows:

Stephen L. Phelps
444 North Oates Street
Dothan, Alabama 36303

6. The corporation is to have perpetual existence.

7. In furtherance and not in limitation of the powers conferred by statute, the board of directors is expressly authorized to make, alter or repeal the by-laws of the corporation.

8. Elections of directors need not be by written ballot unless the by-laws of the corporation shall so provide.

Meetings of stockholders may be held within or without the State of Delaware, as the by-laws nay provide. The books of the corporation may be kept (subject to any provision contained in the statutes) outside the State of Delaware at such place or places as may be designated from time to time by the board of directors or in the by-laws of the corporation.

9. The corporation reserves the right to amend, alter, change or repeal any provision contained in this certificate of incorporation, in the manner now or hereafter prescribed by statute, and all rights conferred upon stockholders herein are granted subject to this reservation.

WE, THE UNDERSIGNED, being each of the incorporators hereinbefore named, for the purpose of forming a corporation pursuant to the General Corporation Law of the State of Delaware, do make this certificate, hereby declaring and certifying that this is our act and deed and the facts herein stated are true, and accordingly have hereunto set our hands this 23rd day of May, 1986.

/s/ D.A. Hampton
Name: D.A. Hampton

/s/ J.A. Grodzicki
Name: J.A. Grodzicki

/s/ S. J. Queppett
Name: S. J. Queppett

STATE OF DELAWARE
SECRETARY OF STATE
DIVISION OF CORPORATIONS
FILED 09:00 AM 11/01/1994
944209828 — 2091881

CERTIFICATE OF CHANGE OF LOCATION OF REGISTERED

OFFICE AND REGISTERED AGENT

OF

NATIONAL HEALTHCARE OF CULLMAN, INC.

The Board of Directors of:

NATIONAL HEALTHCARE OF CULLMAN, INC.

a Corporation of the State of Delaware, on this 25th day of October, A.D. 1994, do hereby resolve and order that the location of the Registered Office of this Corporation within this State be, and the same hereby is:

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1013 Centre Road, in the City of Wilmington, in the County of New Castle, Delaware, 19805.

The name of the Registered Agent therein and in charge thereof upon whom process against the Corporation may be served, is: CORPORATION SERVICE COMPANY.

NATIONAL HEALTHCARE OF CULLMAN, INC.

a Corporation of the State of Delaware, does hereby certify that the foregoing is a true copy of a resolution adopted by the Board of Directors at a meeting held as herein stated.

IN WITNESS WHEREOF, said corporation has caused this

Certificate to be signed by Sara Martin Michels, Assistant Secretary

this 25th day of October A.D. 1994.

/s/ Sara Martin Michels
Name: Sara Martin Michels, Authorized Officer

CERTIFICATE OF CHANGE OF LOCATION OF REGISTERED OFFICE AND OF REGISTERED AGENT

It is hereby certified that:

1. The name of the corporation (hereinafter called the “Corporation”) is NATIONAL HEALTHCARE OF CULLMAN, INC.

2. The registered office of the Corporation within the State of Delaware is hereby changed to 9 East Loockerman Street, Suite 1B, City of Dover 19901, County of Kent.

3. The registered agent of the Corporation within the State of Delaware is hereby changed to National Registered Agents, Inc., the business office of which is identical with the registered office of the corporation as hereby changed.

4. The Corporation has authorized the changes hereinbefore set forth by resolution of its Board of Directors.

Signed on 10-31-03

/s/ Sherry Connelly
Name: Sherry Connelly, Asst. Secretary

State of Delaware
Secretary of State
Division of Corporations
Delivered 10:46 AM 11/12/2003
FILED 09:47 AM 11/12/2003
SRV 030724058 — 2091881 FILE

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