Provider Demographics
NPI:1649216649
Name:AVINO, ANTHONY J (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:J
Last Name:AVINO
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:PO BOX 116336
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-6336
Mailing Address - Country:US
Mailing Address - Phone:912-352-8346
Mailing Address - Fax:912-355-1414
Practice Address - Street 1:4750 WATERS AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6200
Practice Address - Country:US
Practice Address - Phone:912-350-5961
Practice Address - Fax:912-350-5942
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0471852086S0129X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCG47185Medicaid
GA00823567AMedicaid
GA000823567RMedicaid
GA000823567CMedicaid
GA000823567EMedicaid
GA77BBBJGMedicare PIN
GA000823567CMedicaid
GA000823567EMedicaid
GA00823567AMedicaid
G95331Medicare UPIN