Provider Demographics
NPI:1538235122
Name:CUMMINGS, ELIZABETH DIANE (PT)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:DIANE
Last Name:CUMMINGS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1179 BEN JONES RD
Mailing Address - Street 2:
Mailing Address - City:CLARKESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30523-3108
Mailing Address - Country:US
Mailing Address - Phone:678-234-3074
Mailing Address - Fax:706-754-1406
Practice Address - Street 1:1179 BEN JONES RD
Practice Address - Street 2:
Practice Address - City:CLARKESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30523-3108
Practice Address - Country:US
Practice Address - Phone:706-754-1406
Practice Address - Fax:706-754-1406
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT 0007349174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist