Healthcare Provider Details

I. General information

NPI: 1063226488
Provider Name (Legal Business Name): DENECIA GUILFORD PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2025
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 BARRINGTON DR
ATHENS GA
30605-3580
US

IV. Provider business mailing address

352 KOWETA WAY
GROVETOWN GA
30813-7020
US

V. Phone/Fax

Practice location:
  • Phone: 706-389-6790
  • Fax:
Mailing address:
  • Phone: 850-533-2129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number300381
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number300381
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number300381
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number300381
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: