Provider Demographics
NPI:1356630115
Name:GUTHRIE, MARY BENTON (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:BENTON
Last Name:GUTHRIE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:755 MOUNT VERNON HWY NE STE 305
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-4290
Mailing Address - Country:US
Mailing Address - Phone:404-446-4840
Mailing Address - Fax:404-446-4841
Practice Address - Street 1:755 MOUNT VERNON HWY NE STE 305
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-4290
Practice Address - Country:US
Practice Address - Phone:404-446-4840
Practice Address - Fax:404-446-4841
Is Sole Proprietor?:No
Enumeration Date:2011-04-01
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6076363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant