Individual
MR. ANTHONY E. MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2696 LAWRENCEVILLE SUWANEE RD, SUWANEE, GA 30024-2535
(678) 376-1300
(678) 514-2936
Mailing address
2696 LAWRENCEVILLE SUWANEE RD, SUWANEE, GA 30024-2535
(678) 376-1300
(678) 514-2936
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
RC60035704
WA
363AM0700X
Medical Physician Assistant
Primary
006030
GA
Other
Enumeration date
08/11/2008
Last updated
05/18/2011
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