MEDICARE: DR. MYRA ATHENA GUZMAN M.D.

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	207Q00000X	Family Medicine Physician	MD032271E	PA
2	207Q00000X	Family Medicine Physician	23426	SC
3	207Q00000X	Family Medicine Physician	045152	GA
4	207Q00000X	Family Medicine Physician	9800165	NC

General Provider Information

NPI Number	:	1619001211
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MYRA ATHENA GUZMAN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 751274
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28275-1274
Country	:	US
Telephone Number	:	919-620-4467
Fax Number	:	919-620-4921

Provider Business Practice Location Address
First Line	:	10211 ALM ST
Second Line	:	SUITE 1200
City	:	RALEIGH
State	:	NC
Zip	:	27617-8221
Country	:	US
Telephone Number	:	919-620-4467
Fax Number	:	919-620-4921

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

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	03/15/2013

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