Healthcare Provider Details

I. General information

NPI: 1982961009
Provider Name (Legal Business Name): ANDREW THOMAS GUIDRY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2012
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 STARLING ST STE 501
BRUNSWICK GA
31520-4270
US

IV. Provider business mailing address

PO BOX 1213
BRUNSWICK GA
31521-1213
US

V. Phone/Fax

Practice location:
  • Phone: 912-466-4050
  • Fax: 912-261-0226
Mailing address:
  • Phone: 912-466-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084S0010X
TaxonomySports Medicine (Psychiatry & Neurology) Physician
License NumberD82627
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number103854
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: