Provider Demographics
NPI:1821169442
Name:GUMUCIO, CESAR AUGUSTUS (MD)
Entity Type:Individual
Prefix:
First Name:CESAR
Middle Name:AUGUSTUS
Last Name:GUMUCIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:489 N MILLEDGE AVE
Mailing Address - Street 2:
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:
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
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA032744208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
24BCBDHMedicare ID - Type Unspecified
E78662Medicare UPIN