MEDICARE: DR. KIRSTIE DONNYELLE CUNNINGHAM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	048766	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376703975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIRSTIE DONNYELLE CUNNINGHAM MD

Provider Business Mailing Address
First Line	:	2950 STONE HOGAN CONNECTOR RD SW STE B
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-2837
Country	:	US
Telephone Number	:	470-336-9616
Fax Number	:	678-999-2726

Provider Business Practice Location Address
First Line	:	2950 STONE HOGAN CONNECTOR RD SW STE B
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-2837
Country	:	US
Telephone Number	:	470-336-9616
Fax Number	:	678-999-2726

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	10/15/2019

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