Provider Demographics
NPI:1013081652
Name:SOMMERS, GUY H JR (MD)
Entity Type:Individual
Prefix:
First Name:GUY
Middle Name:H
Last Name:SOMMERS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4015 S COBB DR SE
Mailing Address - Street 2:STE 210
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30060
Mailing Address - Country:US
Mailing Address - Phone:770-434-8558
Mailing Address - Fax:770-434-8566
Practice Address - Street 1:4015 S COBB DR SE
Practice Address - Street 2:STE 210
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30060
Practice Address - Country:US
Practice Address - Phone:770-434-8558
Practice Address - Fax:770-434-8566
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA030548208000000X, 2084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Not Answered2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00630781BMedicaid
D30861Medicare UPIN
GA00630781BMedicaid