Individual
CARLOS A MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
500 E OGLETHORPE HWY, HINESVILLE, GA 31313-2804
(843) 577-5011
Mailing address
500 E OGLETHORPE HWY, HINESVILLE, GA 31313-2804
(843) 577-5011
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
123638
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00986172
—
NY
Enumeration date
12/12/2006
Last updated
03/20/2019
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