Healthcare Provider Details

I. General information

NPI: 1598958894
Provider Name (Legal Business Name): WANDA E GUY-CRAFT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 MAIN ST STE 3A
SENOIA GA
30276-1895
US

IV. Provider business mailing address

259 PERSIMMON DRIVE
SHARPSBURG GA
30277
US

V. Phone/Fax

Practice location:
  • Phone: 678-723-0400
  • Fax: 770-566-9779
Mailing address:
  • Phone: 770-815-5229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number64224
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: