Healthcare Provider Details

I. General information

NPI: 1467073148
Provider Name (Legal Business Name): MICHELLE C CUMMINGS CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2020
Last Update Date: 05/04/2020
Certification Date: 05/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 KEYS FERRY ST
MCDONOUGH GA
30253-3298
US

IV. Provider business mailing address

1710 BIRKSHIRE RDG
MCDONOUGH GA
30252-2000
US

V. Phone/Fax

Practice location:
  • Phone: 770-957-1851
  • Fax: 770-957-7434
Mailing address:
  • Phone: 470-526-6057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberPHTC006298
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: