Provider Demographics
NPI:1902400559
Name:GUTHERY FAMILY PRACTICE CLINIC
Entity Type:Organization
Organization Name:GUTHERY FAMILY PRACTICE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:GUTHERY
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:678-615-9519
Mailing Address - Street 1:809 W BANKHEAD HWY STE D
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-1520
Mailing Address - Country:US
Mailing Address - Phone:678-615-9519
Mailing Address - Fax:
Practice Address - Street 1:809 W BANKHEAD HWY STE D
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-1520
Practice Address - Country:US
Practice Address - Phone:678-615-9519
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-24
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty