Healthcare Provider Details

I. General information

NPI: 1871530634
Provider Name (Legal Business Name): GUILHERME CANTUARIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 11/30/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 JOHNSON FERRY RD STE 130
ATLANTA GA
30342-1631
US

IV. Provider business mailing address

960 JOHNSON FERRY RD STE 130
ATLANTA GA
30342-1631
US

V. Phone/Fax

Practice location:
  • Phone: 404-300-2990
  • Fax: 404-300-2986
Mailing address:
  • Phone: 404-300-2990
  • Fax: 404-300-2986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number02103
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number065227
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: