Provider Demographics
NPI:1457339251
Name:TUMMILLO, DORIS ELIZABETH (MD)
Entity Type:Individual
Prefix:MRS
First Name:DORIS
Middle Name:ELIZABETH
Last Name:TUMMILLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 WALTON WAY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-2305
Mailing Address - Country:US
Mailing Address - Phone:706-733-9361
Mailing Address - Fax:706-733-9363
Practice Address - Street 1:137 MIRACLE DR
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-6351
Practice Address - Country:US
Practice Address - Phone:803-641-4874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA036029207RC0000X
SC16031207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00512366BMedicaid
GA06BDFCDMedicare ID - Type Unspecified
E42802Medicare UPIN