Provider Demographics
NPI:1083619282
Name:TORRES, JOSE ANIBAL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ANIBAL
Last Name:TORRES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1468 MONTREAL RD
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-6901
Mailing Address - Country:US
Mailing Address - Phone:470-273-6263
Mailing Address - Fax:678-916-4957
Practice Address - Street 1:771 OLD NORCROSS RD
Practice Address - Street 2:SUITE 310
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4386
Practice Address - Country:US
Practice Address - Phone:770-513-5999
Practice Address - Fax:770-225-3497
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA049152207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000875597OMedicaid
GA511I110203Medicare PIN
H19785Medicare UPIN
GA000427336CMedicaid
GA000427336FMedicaid