Healthcare Provider Details

I. General information

NPI: 1396122891
Provider Name (Legal Business Name): KOURTNEY K GUTHRIE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KOURTNEY K SONDGRASS M.D.

II. Dates (important events)

Enumeration Date: 05/04/2015
Last Update Date: 07/14/2021
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

V. Phone/Fax

Practice location:
  • Phone: 864-838-8635
  • Fax:
Mailing address:
  • Phone: 864-838-8635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME137785
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberME137785
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: