Provider Demographics
NPI:1033443569
Name:CUMBUS, LAWRENCE DWAYNE (SLP)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:DWAYNE
Last Name:CUMBUS
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 OGLETHORPE AVE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2129
Mailing Address - Country:US
Mailing Address - Phone:706-202-1141
Mailing Address - Fax:706-661-0570
Practice Address - Street 1:1175 OGLETHORPE AVE
Practice Address - Street 2:STE B
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2129
Practice Address - Country:US
Practice Address - Phone:706-353-3575
Practice Address - Fax:706-353-1606
Is Sole Proprietor?:No
Enumeration Date:2009-10-01
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP 005149235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA711246114AMedicaid
GA344294OtherWELLCARE
GA01036248OtherAMERIGROUP