Healthcare Provider Details

I. General information

NPI: 1932134525
Provider Name (Legal Business Name): NEAL A GUTTENBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 04/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 PEACHTREE DUNWOODY RD NE SUITE B-420
ATLANTA GA
30328-5382
US

IV. Provider business mailing address

1372 BUCKNER RD SE
MABLETON GA
30126-2711
US

V. Phone/Fax

Practice location:
  • Phone: 404-252-9751
  • Fax: 678-990-5763
Mailing address:
  • Phone: 678-945-9606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.059434
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: