Provider Demographics
NPI:1205802550
Name:RUMPH, DAVID (NP-C)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:RUMPH
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1876
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201
Mailing Address - Country:US
Mailing Address - Phone:478-746-0097
Mailing Address - Fax:478-742-4051
Practice Address - Street 1:446 POPLAR ST. SUITE B
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201
Practice Address - Country:US
Practice Address - Phone:478-746-0097
Practice Address - Fax:478-742-4051
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN104561363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000770745DMedicaid
GA50BBJTJMedicare ID - Type Unspecified