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General NPI Number Information
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NPI Number | 1073007688
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Entity Type | Individual
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Provider Name | ADAM MITCHELL GUNTHARP DO
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Gender | Male
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Dates
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Enumeration Date | 06/18/2018
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Last Update Date | 08/16/2024
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Provider Practice Location Address
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Address Line | 7230 HIGHWAY 45 N STE B
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City | NETTLETON
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State | MS
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Zip | 38858-9399
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Country | US
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Telephone | 662-963-5050
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 305
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City | SMITHVILLE
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State | MS
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Zip | 38870-0305
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 28053
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License Number State | MS
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