Healthcare Provider Details

I. General information

NPI: 1417017757
Provider Name (Legal Business Name): TIMOTHY ARNOLD CUMMINS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2006
Last Update Date: 12/23/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 LOGANVILLE HWY STE 1110
BETHLEHEM GA
30620-2150
US

IV. Provider business mailing address

1815 SILVER OAK DR
BETHLEHEM GA
30620-4532
US

V. Phone/Fax

Practice location:
  • Phone: 678-963-0127
  • Fax:
Mailing address:
  • Phone: 303-913-4904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR010600
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5331
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: