1487691580 NPI number — ANTONIO L RIOS CRNA

Table of content: ANTONIO L RIOS CRNA (NPI 1487691580)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487691580 NPI number — ANTONIO L RIOS CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIOS
Provider First Name:
ANTONIO
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487691580
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/30/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3260 SPAIN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SNELLVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30039-8574
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-361-3584
Provider Business Mailing Address Fax Number:
770-558-3419

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 BALTIMORE PL NW STE 400
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30308-2117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-885-9675
Provider Business Practice Location Address Fax Number:
404-875-4017
Provider Enumeration Date:
05/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  RN037456 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1487691580 . This is a "NPI" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: P00201874 . This is a "RR MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 000550459G , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: N334027 . This is a "WELLCARE MEDICAID" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 1982637419 . This is a "GROUP NPI" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 000550459E , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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