Provider Demographics
NPI:1972685667
Name:BIENVENU-SUMPTER, CUNARDLINE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CUNARDLINE
Middle Name:
Last Name:BIENVENU-SUMPTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7035 HAMPTON BLUFF WAY
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-6747
Mailing Address - Country:US
Mailing Address - Phone:770-993-4492
Mailing Address - Fax:
Practice Address - Street 1:2010 BEAVER RUIN RD
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-3710
Practice Address - Country:US
Practice Address - Phone:770-449-9050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004913363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical