Provider Demographics
NPI:1841184199
Name:CUMBAA, LOGAN AUTRY (DMD)
Entity type:Individual
Prefix:DR
First Name:LOGAN
Middle Name:AUTRY
Last Name:CUMBAA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 DUE SOUTH RD
Mailing Address - Street 2:
Mailing Address - City:WHIGHAM
Mailing Address - State:GA
Mailing Address - Zip Code:39897-4032
Mailing Address - Country:US
Mailing Address - Phone:229-289-7229
Mailing Address - Fax:
Practice Address - Street 1:1215 VINE ST NE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-2535
Practice Address - Country:US
Practice Address - Phone:770-532-4555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-03
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GADN1237871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program