Individual
DR. NILTON D MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
367 ATHENS HWY STE 100, LOGANVILLE, GA 30052-2207
(678) 466-6760
(678) 802-7094
Mailing address
367 ATHENS HWY STE 100, LOGANVILLE, GA 30052-2207
(678) 466-6760
(678) 802-7094
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
244734
MA
208200000X
Plastic Surgery Physician
Primary
91080
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110086073A
—
MA
Enumeration date
04/23/2007
Last updated
06/06/2023
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