Provider Demographics
NPI:1619074853
Name:CUMMING PHYSICAL MEDICINE
Entity Type:Organization
Organization Name:CUMMING PHYSICAL MEDICINE
Other - Org Name:WORTMAN HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:SETH
Authorized Official - Last Name:WORTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-889-3445
Mailing Address - Street 1:1685 MARKET PLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-7936
Mailing Address - Country:US
Mailing Address - Phone:770-889-3445
Mailing Address - Fax:770-889-2212
Practice Address - Street 1:1685 MARKET PLACE BLVD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7936
Practice Address - Country:US
Practice Address - Phone:770-889-3445
Practice Address - Fax:770-889-2212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA04723111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCBTZMedicare PIN
U90830Medicare UPIN