Healthcare Provider Details

I. General information

NPI: 1770558751
Provider Name (Legal Business Name): THELMA BERRY CUMMINGS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 05/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 STEVE REYNOLDS BOULEVARD KP MEDICAL CENTER AT GWINNETT
DULUTH GA
30086
US

IV. Provider business mailing address

3495 PIEDMONT ROAD NE NINE PIEDMONT CENTER
ATLANTA GA
30305-1736
US

V. Phone/Fax

Practice location:
  • Phone: 770-931-6012
  • Fax:
Mailing address:
  • Phone: 404-364-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN133042
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN133042
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: