Provider Demographics
NPI:1467695932
Name:ROMUALDO M LAYGO MD PC
Entity Type:Organization
Organization Name:ROMUALDO M LAYGO MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROMUALDO
Authorized Official - Middle Name:M
Authorized Official - Last Name:LAYGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-754-6361
Mailing Address - Street 1:PO BOX 348
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:GA
Mailing Address - Zip Code:31329-0348
Mailing Address - Country:US
Mailing Address - Phone:912-754-6361
Mailing Address - Fax:912-754-6069
Practice Address - Street 1:601 N ASH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:GA
Practice Address - Zip Code:31329-4981
Practice Address - Country:US
Practice Address - Phone:912-754-6361
Practice Address - Fax:912-754-6069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA017843174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA017843OtherSTATE LICENSE
GA00114067AMedicaid
D30028OtherUPIN
D30028OtherUPIN
GA00114067AMedicaid