Provider Demographics
NPI:1356459911
Name:CUMMING MEDICAL VENTURES
Entity Type:Organization
Organization Name:CUMMING MEDICAL VENTURES
Other - Org Name:NORTHWOODS MEDICAL SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:E
Authorized Official - Last Name:GOEDTKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-781-6350
Mailing Address - Street 1:1230 BALD RIDGE MARINA RD
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-7536
Mailing Address - Country:US
Mailing Address - Phone:770-781-6350
Mailing Address - Fax:770-781-6357
Practice Address - Street 1:1230 BALD RIDGE MARINA RD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7536
Practice Address - Country:US
Practice Address - Phone:770-781-6350
Practice Address - Fax:770-781-6357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP1693Medicare ID - Type Unspecified