Provider Demographics
NPI:1083767289
Name:GUMBS, CEPHAS S (PT)
Entity Type:Individual
Prefix:
First Name:CEPHAS
Middle Name:S
Last Name:GUMBS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1334
Mailing Address - Street 2:
Mailing Address - City:JESUP
Mailing Address - State:GA
Mailing Address - Zip Code:31598-1334
Mailing Address - Country:US
Mailing Address - Phone:912-427-0800
Mailing Address - Fax:
Practice Address - Street 1:110 PROFESSIONAL CT
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31545-0044
Practice Address - Country:US
Practice Address - Phone:912-427-0800
Practice Address - Fax:912-427-6029
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT006530225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA197213416AMedicaid