Organization
SANTO NINO PEDIATRIC CLINIC, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ALBERTO RICO NAFARRETE (OFFICE MANAGER)
(706) 855-7414
Entity
Organization
Contact information
Practice address
1722 CENTRAL AVE, AUGUSTA, GA 30904-5737
(706) 855-7414
(706) 364-0554
Mailing address
1722 CENTRAL AVE, AUGUSTA, GA 30904-5737
(706) 855-7414
(706) 364-0554
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003683189A
—
GA
01
—
10942549
CAROLINA CARE PLAN
GA
01
—
5444457
CCN(NETWORK)
GA
05
—
GPA837
—
SC
Enumeration date
05/08/2006
Last updated
08/17/2018
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