Provider Demographics
NPI:1043275670
Name:SUMNER, JEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:
Last Name:SUMNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 SPARTA RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:SANDERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31082-1371
Mailing Address - Country:US
Mailing Address - Phone:478-552-0001
Mailing Address - Fax:
Practice Address - Street 1:501 SPARTA RD
Practice Address - Street 2:SUITE F
Practice Address - City:SANDERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31082-1371
Practice Address - Country:US
Practice Address - Phone:478-552-0001
Practice Address - Fax:478-552-0048
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA30225207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00404929AMedicaid
GA110026064OtherRAILROAD MEDICARE
GA023787OtherBCBS
GA00404929BMedicaid
GA023787OtherBCBS
GA11BDBMS01Medicare ID - Type UnspecifiedWRIGHTSVILLE OFFICE
GA11BDBMSMedicare ID - Type Unspecified