Healthcare Provider Details

I. General information

NPI: 1316945355
Provider Name (Legal Business Name): JETTIE ANNE CUMMINGS N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

774 ATHENS RD
LEXINGTON GA
30648-1908
US

IV. Provider business mailing address

PO BOX 69
LEXINGTON GA
30648-0069
US

V. Phone/Fax

Practice location:
  • Phone: 706-743-8183
  • Fax: 706-743-3233
Mailing address:
  • Phone: 706-743-8183
  • Fax: 706-743-3233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR046865
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: