Provider Demographics
NPI:1598958894
Name:GUY-CRAFT, WANDA E (MD)
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:E
Last Name:GUY-CRAFT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 PERSIMMON DRIVE
Mailing Address - Street 2:
Mailing Address - City:SHARPSBURG
Mailing Address - State:GA
Mailing Address - Zip Code:30277
Mailing Address - Country:US
Mailing Address - Phone:770-815-5229
Mailing Address - Fax:
Practice Address - Street 1:48 MAIN ST STE 3A
Practice Address - Street 2:
Practice Address - City:SENOIA
Practice Address - State:GA
Practice Address - Zip Code:30276-1895
Practice Address - Country:US
Practice Address - Phone:678-723-0400
Practice Address - Fax:770-566-9779
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA64224207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA897165685EMedicaid