Provider Demographics
NPI:1972501815
Name:CUMMINGS, JOHNNIE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHNNIE
Middle Name:
Last Name:CUMMINGS
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 1:510 HIGHWAY 322
Mailing Address - Street 2:P O BOX 1216
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614-4717
Mailing Address - Country:US
Mailing Address - Phone:662-624-4292
Mailing Address - Fax:662-624-4354
Practice Address - Street 1:216 HIGHWAY 51 N
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606-2311
Practice Address - Country:US
Practice Address - Phone:662-563-1858
Practice Address - Fax:662-563-0617
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS12250207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0019926Medicaid
MSA99535Medicare UPIN
MS0019926Medicaid