Provider Demographics
NPI:1831301654
Name:SESSUMS, CYNTHIA WITT (DO)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:WITT
Last Name:SESSUMS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7590 PLEASANTVILLE WAY
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813-1218
Mailing Address - Country:US
Mailing Address - Phone:706-868-5893
Mailing Address - Fax:
Practice Address - Street 1:1120 15TH ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-0004
Practice Address - Country:US
Practice Address - Phone:706-721-4951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001904207P00000X
VA0102202354207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA001904OtherRESIDENCY TRAINING PERMIT
WV3810016159Medicaid
VA114228OtherBCBS VA
VA1831301654Medicaid
VA114228OtherBCBS VA
VA021405V21Medicare PIN
VA1831301654Medicaid
VAVAA113373Medicare PIN
VA021490E98Medicare PIN
WV3810016159Medicaid