Provider Demographics
NPI:1073007688
Name:GUNTHARP, ADAM MITCHELL (DO)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:MITCHELL
Last Name:GUNTHARP
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 305
Mailing Address - Street 2:
Mailing Address - City:SMITHVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38870-0305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:60021 MONROE ST
Practice Address - Street 2:
Practice Address - City:SMITHVILLE
Practice Address - State:MS
Practice Address - Zip Code:38870-7779
Practice Address - Country:US
Practice Address - Phone:662-651-4637
Practice Address - Fax:662-651-4687
Is Sole Proprietor?:No
Enumeration Date:2018-06-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS28053207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1578289OtherBLUECROSS BLUESHIELD OF MISSISSIPPI
MS02137218Medicaid