Provider Demographics
NPI:1801863105
Name:GUERRA, ERIC RAUL (MD)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:RAUL
Last Name:GUERRA
Suffix:
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:PO BOX 12938
Mailing Address - Street 2:C/O CLINIC MANAGEMENT
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30703
Mailing Address - Country:US
Mailing Address - Phone:706-602-7800
Mailing Address - Fax:
Practice Address - Street 1:1504 N THORNTON AVE STE 106
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-8394
Practice Address - Country:US
Practice Address - Phone:706-602-3215
Practice Address - Fax:423-476-4487
Is Sole Proprietor?:No
Enumeration Date:2006-03-06
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA70754207RI0011X
TNMD29590207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003139491AMedicaid
GA003139491AMedicaid
GAP01335475OtherRR MEDICARE
GA909923OtherWELLCARE
GA01913024OtherAMERIGROUP
TN103I061464Medicare PIN