Healthcare Provider Details

I. General information

NPI: 1477890887
Provider Name (Legal Business Name): DONIECE ROSS CUMMINS RN, ANP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2013
Last Update Date: 06/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1014 FORSYTH ST SUITE 100
MACON GA
31201-2051
US

IV. Provider business mailing address

2490 RIVERSIDE DR STE B
MACON GA
31204-1787
US

V. Phone/Fax

Practice location:
  • Phone: 478-633-8700
  • Fax: 478-633-8710
Mailing address:
  • Phone: 478-633-6633
  • Fax: 478-633-4295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN217465
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2-44278
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN217465
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: