Provider Demographics
NPI:1316945355
Name:CUMMINGS, JETTIE ANNE (NP)
Entity type:Individual
Prefix:
First Name:JETTIE
Middle Name:ANNE
Last Name:CUMMINGS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30648-0069
Mailing Address - Country:US
Mailing Address - Phone:706-743-8183
Mailing Address - Fax:706-743-3233
Practice Address - Street 1:774 ATHENS RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:GA
Practice Address - Zip Code:30648-1908
Practice Address - Country:US
Practice Address - Phone:706-743-8183
Practice Address - Fax:706-743-3233
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAR046865363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00665794AMedicaid
GA00510023AMedicaid
GAR82204Medicare UPIN
GA113880Medicare ID - Type UnspecifiedRURAL HEALTH MEDICARE
GA00665794AMedicaid