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Individual

ANTONIO R SISON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
119 NORMAN DORMINY DR STE C, FITZGERALD, GA 31750-8855
(229) 423-5843
(229) 423-9847
Mailing address
119 NORMAN DORMINY DR STE C, FITZGERALD, GA 31750-8855
(229) 423-5843
(229) 423-9847

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
053172
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
02BDJLF
MEDICARE
GA
05
284021398B
GA
Enumeration date
11/15/2005
Last updated
03/23/2010
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