Healthcare Provider Details

I. General information

NPI: 1861396749
Provider Name (Legal Business Name): MR. BILLYE GUTHRIE JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MR. BJ GUTHRIE

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 15TH STREET NE 5D HANOVER HOUSE
ATLANTA GA
30309-3562
US

IV. Provider business mailing address

147 15TH STREET NE 5D HANOVER HOUSE
ATLANTA GA
30309-3562
US

V. Phone/Fax

Practice location:
  • Phone: 404-931-3331
  • Fax:
Mailing address:
  • Phone: 404-931-3331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN144210
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: