Provider Demographics
NPI:1720140551
Name:ABERNATHY, ANDREW H III (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:H
Last Name:ABERNATHY
Suffix:III
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 1:1000 COWLES CLINC WAY STE W-200
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30642-4539
Mailing Address - Country:US
Mailing Address - Phone:706-923-2002
Mailing Address - Fax:
Practice Address - Street 1:1000 COWLES CLINC WAY STE W-200
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:GA
Practice Address - Zip Code:30642-4539
Practice Address - Country:US
Practice Address - Phone:706-923-2002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA 11257207R00000X
GAGA11257207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I066222Medicare PIN
GAE00978Medicare UPIN
GA111257010AMedicare ID - Type Unspecified