Provider Demographics
NPI:1336132646
Name:NAVARRO, ROMULO P (MD)
Entity Type:Individual
Prefix:DR
First Name:ROMULO
Middle Name:P
Last Name:NAVARRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 WARD STREET EXT W
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31533-1902
Mailing Address - Country:US
Mailing Address - Phone:912-384-1477
Mailing Address - Fax:912-384-1470
Practice Address - Street 1:100 DOCTORS DR STE C
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-2211
Practice Address - Country:US
Practice Address - Phone:912-384-5832
Practice Address - Fax:912-383-8279
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2023-03-07
Deactivation Date:2006-03-27
Deactivation Code:
Reactivation Date:2006-04-04
Provider Licenses
StateLicense IDTaxonomies
GA023646208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00603468OtherRAILROAD MEDICARE - PTAN
GA000199328CMedicaid
GA11D0265294OtherCLIA ID - 1309 OCILLA RD - STE A
GADH1281OtherRAILROAD MEDICARE - GROUP #
GA11D1105865OtherCLIA ID - 17 JOHNSON ST
GA341237OtherWELLCARE
GA023646OtherPHYSICIAN LICENSE #
GA000199328BMedicaid
GA000199328BMedicaid
GA023646OtherPHYSICIAN LICENSE #
GAAN9377816OtherDEA
GAGRP7930Medicare PIN