Individual
LAWRENCE DWAYNE CUMBUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SLP
Contact information
Practice address
1175 OGLETHORPE AVE, STE B, ATHENS, GA 30606-2129
(706) 353-3575
(706) 353-1606
Mailing address
1175 OGLETHORPE AVE, ATHENS, GA 30606-2129
(706) 202-1141
(706) 661-0570
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP 005149
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01036248
AMERIGROUP
GA
01
—
344294
WELLCARE
GA
05
—
711246114A
—
GA
Enumeration date
10/01/2009
Last updated
11/22/2017
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