Healthcare Provider Details

I. General information

NPI: 1144337023
Provider Name (Legal Business Name): CUMMING FAMILY MEDICINE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 LANIER 400 PKWY
CUMMING GA
30040-2539
US

IV. Provider business mailing address

765 LANIER 400 PKWY
CUMMING GA
30040-2539
US

V. Phone/Fax

Practice location:
  • Phone: 770-205-1294
  • Fax: 770-205-1783
Mailing address:
  • Phone: 770-205-1294
  • Fax: 770-205-1783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number032759
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JEEVANA KRISHNA
Title or Position: OWNER
Credential: M.D.
Phone: 770-205-1274