Provider Demographics
NPI:1558348300
Name:SHUMPERT, CYNTHIA R (MD)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:R
Last Name:SHUMPERT
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 1:15 RIVEBEND DRIVE
Mailing Address - Street 2:STE 100
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161
Mailing Address - Country:US
Mailing Address - Phone:706-291-0884
Mailing Address - Fax:706-235-0405
Practice Address - Street 1:15 RIVEBEND DRIVE
Practice Address - Street 2:STE 100
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161
Practice Address - Country:US
Practice Address - Phone:706-291-0884
Practice Address - Fax:706-235-0405
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA029782207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000374778HMedicaid
08BBRRTMedicare ID - Type Unspecified
E01053Medicare UPIN