Provider Demographics
NPI:1013020791
Name:CUNANAN, LINDA C (MD)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:C
Last Name:CUNANAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 KNIGHT DR
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263
Mailing Address - Country:US
Mailing Address - Phone:770-251-0135
Mailing Address - Fax:
Practice Address - Street 1:109 BULLSBORO DR
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-1017
Practice Address - Country:US
Practice Address - Phone:770-251-4140
Practice Address - Fax:770-251-7275
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA20861207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00186205AMedicaid
GA00186205AMedicaid