Provider Demographics
NPI:1790047579
Name:CESAR A. GUMUCIO, MD, PC
Entity Type:Organization
Organization Name:CESAR A. GUMUCIO, MD, PC
Other - Org Name:GUMUCIO PLASTIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CESAR
Authorized Official - Middle Name:A
Authorized Official - Last Name:GUMUCIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACS
Authorized Official - Phone:706-613-6650
Mailing Address - Street 1:489 N MILLEDGE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30601-3807
Mailing Address - Country:US
Mailing Address - Phone:706-613-6650
Mailing Address - Fax:706-613-6868
Practice Address - Street 1:489 N MILLEDGE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30601-3807
Practice Address - Country:US
Practice Address - Phone:706-613-6650
Practice Address - Fax:706-613-6868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA32744208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAE78662Medicare UPIN