Provider Demographics
NPI:1265418065
Name:GUICHARD, KRISTA B (MD)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:B
Last Name:GUICHARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:L
Other - Last Name:BRUNNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3155 N POINT PKWY
Mailing Address - Street 2:BUILDING D SUITE 200
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-5481
Mailing Address - Country:US
Mailing Address - Phone:770-667-6967
Mailing Address - Fax:866-578-7440
Practice Address - Street 1:3155 N POINT PKWY
Practice Address - Street 2:BUILDING D SUITE 200
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-5481
Practice Address - Country:US
Practice Address - Phone:770-667-6967
Practice Address - Fax:866-578-7440
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055367208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA820686829AMedicaid
GA820686829BMedicaid