Individual
DR. ANTONIO LUIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1013 FERNWOOD DR, STE B, MILLEDGEVILLE, GA 31061-5428
(478) 251-6924
(478) 295-3644
Mailing address
1013 FERNWOOD DR, STE B, MILLEDGEVILLE, GA 31061-5428
(478) 251-6924
(478) 295-3644
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
023759
GA
2084P0800X
Psychiatry Physician
23579
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
023759
LICENSE #
GA
Enumeration date
04/07/2009
Last updated
10/10/2019
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