MEDICARE: KYJUAN CUMMINGS

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	106S00000X	Behavior Technician		GA

General Provider Information

NPI Number	:	1639022940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYJUAN CUMMINGS

Provider Business Mailing Address
First Line	:	1047 WESTCHESTER LN
Second Line	:
City	:	THOMSON
State	:	GA
Zip	:	30824-3046
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1047 WESTCHESTER LN
Second Line	:
City	:	THOMSON
State	:	GA
Zip	:	30824-3046
Country	:	US
Telephone Number	:	706-466-6587
Fax Number	:

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

Provider Enumeration Date	:	02/17/2026
Last Update Date	:	02/17/2026

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Directions to “ KYJUAN CUMMINGS ” Practice Location

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