Provider Demographics
NPI:1679831226
Name:GUMBS, WANDA S (MD)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:S
Last Name:GUMBS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3699 CASCADE RD SW
Mailing Address - Street 2:SUITE B2
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-2163
Mailing Address - Country:US
Mailing Address - Phone:404-691-7006
Mailing Address - Fax:404-691-4609
Practice Address - Street 1:3699 CASCADE RD SW
Practice Address - Street 2:SUITE B2
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-2163
Practice Address - Country:US
Practice Address - Phone:404-691-7006
Practice Address - Fax:404-691-4609
Is Sole Proprietor?:No
Enumeration Date:2012-05-01
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA73086207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine