Individual
CARLOS A LEVY-ELICEIRI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD PA
Contact information
Practice address
100 LAKESHORE DR, SUITE B, SAINT MARYS, GA 31558-3800
(912) 882-4254
(812) 882-9493
Mailing address
100 LAKESHORE DR, SUITE B, SAINT MARYS, GA 31558-3800
(912) 882-4254
(888) 512-9114
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
019967
GA
208D00000X
General Practice Physician
Primary
019967
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00176272A
—
GA
Enumeration date
09/22/2005
Last updated
10/05/2018
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