Provider Demographics
NPI:1962176784
Name:TUMLIN, BENTLIE COX (NP)
Entity type:Individual
Prefix:MRS
First Name:BENTLIE
Middle Name:COX
Last Name:TUMLIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:352 STONEWOOD CREEK DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-9314
Mailing Address - Country:US
Mailing Address - Phone:706-987-4284
Mailing Address - Fax:
Practice Address - Street 1:3755 SIXES RD STE 203
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-7847
Practice Address - Country:US
Practice Address - Phone:678-880-6698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-04
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN289613363LA2200X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health