Provider Demographics
NPI:1902920895
Name:HUNSUCKER, TIMOTHY LYN (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:LYN
Last Name:HUNSUCKER
Suffix:
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 1:1745 PHOENIX BLVD STE 240
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-5534
Mailing Address - Country:US
Mailing Address - Phone:912-571-9062
Mailing Address - Fax:
Practice Address - Street 1:1745 PHOENIX BLVD STE 240
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30349-5534
Practice Address - Country:US
Practice Address - Phone:912-571-9062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-18
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0413182084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000711147DMedicaid
GAB23655Medicare UPIN
GA26BDGRDMedicare ID - Type Unspecified