Healthcare Provider Details

I. General information

NPI: 1053371716
Provider Name (Legal Business Name): REBECCA C TUMMONS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 05/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1269 US HIGHWAY 221A
FOREST CITY NC
28043-5921
US

IV. Provider business mailing address

1269 US HIGHWAY 221A
FOREST CITY NC
28043-5921
US

V. Phone/Fax

Practice location:
  • Phone: 828-657-5371
  • Fax: 828-657-9190
Mailing address:
  • Phone: 828-657-5371
  • Fax: 828-657-9190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35774
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number15004
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: