Healthcare Provider Details

I. General information

NPI: 1649363532
Provider Name (Legal Business Name): ANTHY DEMESTIHAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2965 PEACHTREE RD NE UNIT 1604
ATLANTA GA
30305-3390
US

IV. Provider business mailing address

2965 PEACHTREE RD NE UNIT 1604
ATLANTA GA
30305-3390
US

V. Phone/Fax

Practice location:
  • Phone: 203-650-2159
  • Fax:
Mailing address:
  • Phone: 203-650-2159
  • Fax: 203-332-4751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number90268
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2607
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number030627
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: