Provider Demographics
NPI:1942967864
Name:LUMPKIN, DEVAUGHN
Entity Type:Individual
Prefix:
First Name:DEVAUGHN
Middle Name:
Last Name:LUMPKIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1164 CROSS VALLEY CV
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-6637
Mailing Address - Country:US
Mailing Address - Phone:901-562-9415
Mailing Address - Fax:
Practice Address - Street 1:1560 WEMBLEY DR
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-6445
Practice Address - Country:US
Practice Address - Phone:470-322-6734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-27
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide