Individual
RODOLFO BARTOLOME CARRILLO SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
420 BROAD ST SE, GAINESVILLE, GA 30501-3726
(770) 536-8885
(770) 536-8725
Mailing address
420 BROAD ST SE, GAINESVILLE, GA 30501
(770) 536-8885
(770) 536-8725
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
033243
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0TH000
—
GA
Enumeration date
10/16/2006
Last updated
07/08/2007
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