Provider Demographics
NPI:1942495833
Name:WESTBERRY, CYNTHIA J (MD)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:J
Last Name:WESTBERRY
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 1097
Mailing Address - Street 2:
Mailing Address - City:JESUP
Mailing Address - State:GA
Mailing Address - Zip Code:31598-1097
Mailing Address - Country:US
Mailing Address - Phone:912-385-2702
Mailing Address - Fax:912-385-2703
Practice Address - Street 1:930 S 1ST ST
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31545-0202
Practice Address - Country:US
Practice Address - Phone:912-385-2702
Practice Address - Fax:912-385-2703
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-13
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001923207R00000X
GA062089207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA111075034FMedicaid
GA202I113077Medicare PIN