Healthcare Provider Details

I. General information

NPI: 1205078730
Provider Name (Legal Business Name): EMILY S CUMMINS NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2009
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 OLD PHILADELPHIA RD STE G100
JASPER GA
30143-4044
US

IV. Provider business mailing address

1101 OLD PHILADELPHIA RD # G100
JASPER GA
30143-4044
US

V. Phone/Fax

Practice location:
  • Phone: 678-971-4167
  • Fax: 706-253-7060
Mailing address:
  • Phone: 678-971-4167
  • Fax: 706-253-7060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP149914
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: