Provider Demographics
NPI:1447317904
Name:GUNBY, TONYA M (DMD)
Entity type:Individual
Prefix:DR
First Name:TONYA
Middle Name:M
Last Name:GUNBY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 SCREVEN ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30434-1722
Mailing Address - Country:US
Mailing Address - Phone:478-625-3662
Mailing Address - Fax:478-625-8159
Practice Address - Street 1:502 SCREVEN ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:GA
Practice Address - Zip Code:30434-1722
Practice Address - Country:US
Practice Address - Phone:478-625-3662
Practice Address - Fax:478-625-8159
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0113741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA859309OtherUNITED CONCORDIA PIN
GA000667829AMedicaid
GA859309OtherUNITED CONCORDIA PIN