MEDICARE: WANDA S GUMBS 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	207Q00000X	Family Medicine Physician	73086	GA

General Provider Information

NPI Number	:	1679831226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WANDA S GUMBS M.D.

Provider Business Mailing Address
First Line	:	3699 CASCADE RD SW
Second Line	:	SUITE B2
City	:	ATLANTA
State	:	GA
Zip	:	30331-2163
Country	:	US
Telephone Number	:	404-691-7006
Fax Number	:	404-691-4609

Provider Business Practice Location Address
First Line	:	3699 CASCADE RD SW
Second Line	:	SUITE B2
City	:	ATLANTA
State	:	GA
Zip	:	30331-2163
Country	:	US
Telephone Number	:	404-691-7006
Fax Number	:	404-691-4609

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

Provider Enumeration Date	:	05/01/2012
Last Update Date	:	04/12/2016

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