# CENTRO MEDICO SAN ANTONIO LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1346972858
- **Authorized official:** NANCY REYES (MANAGER)
- **Authorized official phone:** (770) 885-9684

## Contact information

- **Practice address:** 5139 JIMMY CARTER BLVD STE 203, NORCROSS, GA 30093-1638
- **Practice address phone:** (770) 885-9684
- **Mailing address:** 5139 JIMMY CARTER BLVD STE 203, NORCROSS, GA 30093-1638
- **Mailing address phone:** (770) 885-9684

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/24/2022
- **Last updated:** 07/06/2022