Provider Demographics
NPI:1588774814
Name:CUMMINGS, NICHOLAS ALLEN (MD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:ALLEN
Last Name:CUMMINGS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 N RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SALTILLO
Mailing Address - State:MS
Mailing Address - Zip Code:38866-5779
Mailing Address - Country:US
Mailing Address - Phone:662-840-7068
Mailing Address - Fax:
Practice Address - Street 1:63420 HWY 25 N
Practice Address - Street 2:
Practice Address - City:SMITHVILLE
Practice Address - State:MS
Practice Address - Zip Code:38870
Practice Address - Country:US
Practice Address - Phone:662-651-4637
Practice Address - Fax:662-651-4636
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS067132084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03958535Medicaid
MS03958535Medicaid
MSA98806Medicare UPIN