MEDICARE: TIM CUMMINGS, MD LLC

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	174400000X	Specialist	041100	GA

General Provider Information

NPI Number	:	1851572176
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIM CUMMINGS, MD LLC

Provider Business Mailing Address
First Line	:	1260 UPPER HEMBREE ROAD
Second Line	:	SUITE C
City	:	ROSWELL
State	:	GA
Zip	:	30076
Country	:	US
Telephone Number	:	678-356-0484
Fax Number	:	678-356-0480

Provider Business Practice Location Address
First Line	:	1260 UPPER HEMBREE RD
Second Line	:	SUITE C
City	:	ROSWELL
State	:	GA
Zip	:	30076-4611
Country	:	US
Telephone Number	:	678-356-0484
Fax Number	:	678-356-0480

Authorized Official
Title or Position	:	OWNER
Name	:	TIM B CUMMINGS
Credential	:	MD
Telephone Number	:	678-356-0484

Provider Enumeration Date	:	11/15/2007
Last Update Date	:	11/15/2007

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