Provider Demographics
NPI:1790349017
Name:GARSTKA, CYNTHIA LYNCH
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LYNCH
Last Name:GARSTKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 ANSLEY ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-3611
Mailing Address - Country:US
Mailing Address - Phone:404-234-0157
Mailing Address - Fax:
Practice Address - Street 1:605 ANSLEY ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-3611
Practice Address - Country:US
Practice Address - Phone:404-234-0157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-23
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA029297957OtherGEORGIA STATE DRIVERS LICENSE