Provider Demographics
NPI:1649372970
Name:CUMMINGS, CERISIA A (DO)
Entity type:Individual
Prefix:DR
First Name:CERISIA
Middle Name:A
Last Name:CUMMINGS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 OBADIAH LN
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37355-4935
Mailing Address - Country:US
Mailing Address - Phone:931-728-8314
Mailing Address - Fax:
Practice Address - Street 1:225 FIRST ST
Practice Address - Street 2:
Practice Address - City:ARNOLD AIR FORCE BASE
Practice Address - State:TN
Practice Address - Zip Code:37389-2402
Practice Address - Country:US
Practice Address - Phone:931-454-6134
Practice Address - Fax:931-454-6137
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TND0719208D00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3302008Medicaid
TNC-47004Medicare UPIN
TN68390Medicare ID - Type Unspecified