Individual
ANA R FERNANDES LONGUINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1120 15TH ST, AUGUSTA, GA 30912-0001
(706) 721-8623
Mailing address
1120 15TH ST STE BI-1056, AUGUSTA, GA 30912-0004
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
84377
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
84377
GA MEDICAL LICENSE
GA
Enumeration date
10/28/2014
Last updated
11/13/2019
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