Provider Demographics
NPI:1285442541
Name:CUPITT, WANDA SUE (CPT)
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:SUE
Last Name:CUPITT
Suffix:
Gender:F
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2135 HIGHWAY 212
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016-6084
Mailing Address - Country:US
Mailing Address - Phone:404-757-9843
Mailing Address - Fax:
Practice Address - Street 1:2135 HIGHWAY 212
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016-6084
Practice Address - Country:US
Practice Address - Phone:404-757-9843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker