Provider Demographics
NPI:1356591721
Name:CUNNINGHAM, DEBORAH ANNE (MD)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANNE
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:ANNE
Other - Last Name:ELGISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:975 JOHNSON FERRY RD.
Mailing Address - Street 2:STE 500
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342
Mailing Address - Country:US
Mailing Address - Phone:404-255-8086
Mailing Address - Fax:404-531-4962
Practice Address - Street 1:975 JOHNSON FERRY RD.
Practice Address - Street 2:STE 500
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342
Practice Address - Country:US
Practice Address - Phone:404-255-8086
Practice Address - Fax:404-531-4962
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0700772085R0202X
MA2438542085R0202X
GA700772085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110087774AMedicaid
GA070077OtherGEORGIA MEDICAL LICENSE