Individual
DR. LERISSA ANN ANTONIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5354 REYNOLDS ST STE 424, SAVANNAH, GA 31405-6011
(912) 819-8999
Mailing address
1 SOUNDING POINT RETREAT, SAVANNAH, GA 31411-2839
(912) 272-5549
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
70521
GA
208M00000X
Hospitalist Physician
070521
GA
208M00000X
Hospitalist Physician
83925
SC
208M00000X
Hospitalist Physician
ME133162
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
022139100
—
FL
01
—
JC391Z
MEDICARE
FL
01
—
SCH508K108
MEDICARE
SC
Enumeration date
04/30/2010
Last updated
02/01/2023
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