Basic Information
| Provider Information | |||||||||
| NPI: | 1083605968 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUERCIO | ||||||||
| FirstName: | CYNTHIA | ||||||||
| MiddleName: | V. | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1700 HOSPITAL SOUTH DR. SUITE 500 | ||||||||
| Address2: | SOUTH COBB OB-GYN | ||||||||
| City: | AUSTELL | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709417717 | ||||||||
| FaxNumber: | 7707399384 | ||||||||
| Practice Location | |||||||||
| Address1: | 1700 HOSPITAL SOUTH DR. SUITE 500 | ||||||||
| Address2: | SOUTH COBB OB-GYN | ||||||||
| City: | AUSTELL | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709417717 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2005 | ||||||||
| LastUpdateDate: | 08/26/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | ARNP2798652 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 367A00000X | RN197647 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 304425400 | 05 | FL | MEDICAID |