| Antonio Luis, M.d., Llc | |
|
1013 Fernwood Dr Ste C Milledgeville GA 31061-5428 | |
| (478) 251-6924 | |
| (478) 295-3644 |
| Full Name | Antonio Luis, M.d., Llc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 1013 Fernwood Dr Ste C, Milledgeville, Georgia |
| Authorized Official Name and Position | Dennis Braddy (PRACTICE ADMINISTRATOR) |
| Authorized Official Contact | 4782950526 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Antonio Luis, M.d., Llc 1013 Fernwood Dr Ste C Milledgeville GA 31061-5428 Ph: (478) 251-6924 | Antonio Luis, M.d., Llc 1013 Fernwood Dr Ste C Milledgeville GA 31061-5428 Ph: (478) 251-6924 |
| NPI Number | 1912627126 |
|---|---|
| Provider Enumeration Date | 08/29/2022 |
| Last Update Date | 08/30/2022 |
| Certification Date | 08/30/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912627126 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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