Provider Demographics
NPI:1720095177
Name:CUMMINGS, TIMOTHY BRIAN (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:BRIAN
Last Name:CUMMINGS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 UPPER HEMBREE ROAD
Mailing Address - Street 2:SUITE C
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076
Mailing Address - Country:US
Mailing Address - Phone:678-356-0484
Mailing Address - Fax:678-356-0480
Practice Address - Street 1:1260 UPPER HEMBREE ROAD
Practice Address - Street 2:SUITE C
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076
Practice Address - Country:US
Practice Address - Phone:678-356-0484
Practice Address - Fax:678-356-0480
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA041100207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
11D1004401OtherCLIA
GRP4985OtherMEDICARE GROUP
D99093Medicare UPIN
11D1004401OtherCLIA