MEDICARE: CARA B CIMMINO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program	229660	MA
2	208800000X	Urology Physician	0101251383	VA
3	208800000X	Urology Physician	69387	GA

General Provider Information

NPI Number	:	1275704652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARA B CIMMINO M.D.

Provider Business Mailing Address
First Line	:	1365 CLIFTON RD NE
Second Line	:	CLINIC BUILDING B, SUITE B1400
City	:	ATLANTA
State	:	GA
Zip	:	30322-1013
Country	:	US
Telephone Number	:	404-778-4813
Fax Number	:	404-778-4006

Provider Business Practice Location Address
First Line	:	1365 CLIFTON RD NE
Second Line	:	CLINIC BUILDING B, SUITE B1400
City	:	ATLANTA
State	:	GA
Zip	:	30322-1013
Country	:	US
Telephone Number	:	404-778-4813
Fax Number	:	404-778-4006

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2008
Last Update Date	:	06/17/2026

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