=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255503934
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TONYA M GUNBY DMD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2008
-----------------------------------------------------
Last Update Date | 04/02/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 502 SCREVEN STREET
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30434
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-625-3662
-----------------------------------------------------
Fax | 478-625-8159
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 228
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30434
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-625-3662
-----------------------------------------------------
Fax | 478-625-8159
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | TONYA M GUNBY
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 478-625-3662
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 011374
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------