Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | CHIR002424 | GA |
NPI | 1073079687 |
---|---|
Provider Name | Dr. Guy Theron Gunter III |
First Address | Atlanta, GA 30342-9478 |
Second Address | Atlanta, GA 30342-2678 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2019 |
Last Update Date | 19/02/2019 |