Provider Demographics
NPI:1982882338
Name:CUMBERLAND OBGYN
Entity Type:Organization
Organization Name:CUMBERLAND OBGYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-541-1028
Mailing Address - Street 1:1611 SANDS PL SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8785
Mailing Address - Country:US
Mailing Address - Phone:770-541-1028
Mailing Address - Fax:770-541-2229
Practice Address - Street 1:1611 SANDS PL SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8785
Practice Address - Country:US
Practice Address - Phone:770-541-1028
Practice Address - Fax:770-541-2229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA31197207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD28848Medicare UPIN
GAGRP2656Medicare PIN