Provider Demographics
NPI:1649363532
Name:DEMESTIHAS, ANTHY (MD)
Entity type:Individual
Prefix:
First Name:ANTHY
Middle Name:
Last Name:DEMESTIHAS
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 1:2965 PEACHTREE RD NE UNIT 1604
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-3390
Mailing Address - Country:US
Mailing Address - Phone:203-650-2159
Mailing Address - Fax:203-332-4751
Practice Address - Street 1:2965 PEACHTREE RD NE UNIT 1604
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-3390
Practice Address - Country:US
Practice Address - Phone:203-650-2159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA90268208600000X
WI2607208600000X
CT030627208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTF29019Medicare UPIN
CTF29019Medicare UPIN