Provider Demographics
NPI:1316171416
Name:JUNCO, ANTHONY JR (MD)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:
Last Name:JUNCO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 N 3RD ST
Mailing Address - Street 2:P O BOX 398
Mailing Address - City:GLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30428
Mailing Address - Country:US
Mailing Address - Phone:912-523-5113
Mailing Address - Fax:912-523-2049
Practice Address - Street 1:111 N 3RD STREET
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:GA
Practice Address - Zip Code:30428
Practice Address - Country:US
Practice Address - Phone:912-523-5113
Practice Address - Fax:912-523-2049
Is Sole Proprietor?:No
Enumeration Date:2009-05-05
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA38821207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine