Individual
FLORIDA SELGA BASILIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1519 13TH AVE, COLUMBUS, GA 31901-1908
(706) 576-5570
(706) 576-4049
Mailing address
1519 13TH AVE, COLUMBUS, GA 31901-1908
(706) 576-5570
(706) 576-4049
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
028720
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000327137E
PEACH STATE HEALTH PLAN
GA
05
—
000327137E
—
GA
01
—
306087
WELLCARE
GA
01
—
52236043
BCBS GA
GA
01
—
60024312
BCBS AL
AL
Enumeration date
02/23/2007
Last updated
08/13/2014
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