Healthcare Provider Details

I. General information

NPI: 1740002229
Provider Name (Legal Business Name): TOWANNA CUMMINGS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 BLUEBIRD BLVD
FORT VALLEY GA
31030-5081
US

IV. Provider business mailing address

604 BLUEBIRD BLVD
FORT VALLEY GA
31030-5081
US

V. Phone/Fax

Practice location:
  • Phone: 404-877-2487
  • Fax:
Mailing address:
  • Phone: 478-825-2031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN-NP415497
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN315497
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: