Provider Demographics
NPI:1508987488
Name:CUMMINGS, LEIGH A (DMD)
Entity Type:Individual
Prefix:DR
First Name:LEIGH
Middle Name:A
Last Name:CUMMINGS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3380 OLD JEFFERSON RD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30607-1480
Mailing Address - Country:US
Mailing Address - Phone:706-548-3279
Mailing Address - Fax:706-546-6475
Practice Address - Street 1:3380 OLD JEFFERSON RD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30607-1480
Practice Address - Country:US
Practice Address - Phone:706-548-3279
Practice Address - Fax:706-546-6475
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0119001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00862705AMedicaid