Provider Demographics
NPI:1265707475
Name:LUMPKIN, KATHY P (CNA)
Entity type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:P
Last Name:LUMPKIN
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:MRS
Other - First Name:KATHY
Other - Middle Name:
Other - Last Name:POTEET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNA
Mailing Address - Street 1:2073 FREEPORT RD NW
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-6958
Mailing Address - Country:US
Mailing Address - Phone:706-281-2123
Mailing Address - Fax:
Practice Address - Street 1:2073 FREEPORT RD NW
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-6958
Practice Address - Country:US
Practice Address - Phone:706-281-2123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-21
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0000041282374U00000X, 376K00000X
376J00000X, 372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker
No372600000XNursing Service Related ProvidersAdult Companion
No376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003122523AMedicaid
GA9763354OtherCIGNA INSURANCE