Provider Demographics
NPI:1255503934
Name:TONYA M GUNBY DMD PC
Entity Type:Organization
Organization Name:TONYA M GUNBY DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GUNBY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:478-625-3662
Mailing Address - Street 1:PO BOX 228
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30434
Mailing Address - Country:US
Mailing Address - Phone:478-625-3662
Mailing Address - Fax:478-625-8159
Practice Address - Street 1:502 SCREVEN STREET
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:GA
Practice Address - Zip Code:30434
Practice Address - Country:US
Practice Address - Phone:478-625-3662
Practice Address - Fax:478-625-8159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA011374122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA859309OtherUNITED CONCORDIA