Provider Demographics
NPI:1710865837
Name:CUMMINGS, JAQWAN T (OCPRS)
Entity type:Individual
Prefix:
First Name:JAQWAN
Middle Name:T
Last Name:CUMMINGS
Suffix:
Gender:M
Credentials:OCPRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1176 WARREN RD APT 11
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-2590
Mailing Address - Country:US
Mailing Address - Phone:216-776-8178
Mailing Address - Fax:
Practice Address - Street 1:1176 WARREN RD APT 11
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-2590
Practice Address - Country:US
Practice Address - Phone:216-776-8178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-26
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS.006611175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist