Provider Demographics
NPI:1568572584
Name:ANTHONY, BETTY L (MD)
Entity Type:Individual
Prefix:DR
First Name:BETTY
Middle Name:L
Last Name:ANTHONY
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:PO BOX 598
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-0598
Mailing Address - Country:US
Mailing Address - Phone:770-476-1088
Mailing Address - Fax:678-206-0346
Practice Address - Street 1:6300 HOSPITAL PKWY STE 200
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-1984
Practice Address - Country:US
Practice Address - Phone:770-476-1088
Practice Address - Fax:770-476-1082
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA45385207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
16BDSNCMedicare ID - Type Unspecified