Healthcare Provider Details

I. General information

NPI: 1073079687
Provider Name (Legal Business Name): GUY THERON GUNTER III DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2019
Last Update Date: 02/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4969 ROSWELL RD STE 100-105
ATLANTA GA
30342-2678
US

IV. Provider business mailing address

PO BOX 422478
ATLANTA GA
30342-9478
US

V. Phone/Fax

Practice location:
  • Phone: 404-255-3110
  • Fax: 404-256-6547
Mailing address:
  • Phone: 404-255-3110
  • Fax: 404-256-6547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberCHIR002424
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: