Provider Demographics
NPI:1518926427
Name:CUMMINGS, CHARLES RICHARD JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:RICHARD
Last Name:CUMMINGS
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:5115 NEW PEACHTREE RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CHAMBLEE
Mailing Address - State:GA
Mailing Address - Zip Code:30341-3326
Mailing Address - Country:US
Mailing Address - Phone:678-336-5951
Mailing Address - Fax:678-336-5955
Practice Address - Street 1:980 JOHNSON FY RD NE
Practice Address - Street 2:SUITE 880
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1626
Practice Address - Country:US
Practice Address - Phone:404-252-0503
Practice Address - Fax:404-252-8802
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2013-09-11
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Provider Licenses
StateLicense IDTaxonomies
GA026493208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
91ZCBDCMedicare ID - Type Unspecified
D39671Medicare UPIN