Provider Demographics
NPI:1144268541
Name:GUNCHICK, KATHLEEN MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:MARIE
Last Name:GUNCHICK
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 1:1646 MOUNT PARAN RD NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-3806
Mailing Address - Country:US
Mailing Address - Phone:404-467-4865
Mailing Address - Fax:
Practice Address - Street 1:1000 CHASTAIN ROAD MD 5200 HOUSE 52
Practice Address - Street 2:KENNESAW STATE UNIVERSITY HEALTH CLINIC
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-5591
Practice Address - Country:US
Practice Address - Phone:770-423-6644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA028760207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000381796LMedicaid
GA000381796LMedicaid
GA93BFBRTMedicare ID - Type Unspecified