Healthcare Provider Details

I. General information

NPI: 1639182132
Provider Name (Legal Business Name): ANTHONY F HUMAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 09/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250B AUBURN RD SUITE 201
DACULA GA
30019-5432
US

IV. Provider business mailing address

1250B AUBURN RD SUITE 201
DACULA GA
30019-5432
US

V. Phone/Fax

Practice location:
  • Phone: 678-689-6888
  • Fax: 678-689-6881
Mailing address:
  • Phone: 678-689-6888
  • Fax: 678-689-6881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number056072
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: