Provider Demographics
NPI:1760703540
Name:CARLOS A. LEVY, MD, PA
Entity Type:Organization
Organization Name:CARLOS A. LEVY, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:AVILES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-882-5553
Mailing Address - Street 1:100 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-3857
Mailing Address - Country:US
Mailing Address - Phone:912-882-5553
Mailing Address - Fax:812-882-9493
Practice Address - Street 1:100 LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-3857
Practice Address - Country:US
Practice Address - Phone:912-882-5553
Practice Address - Fax:812-882-9493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-16
Last Update Date:2018-12-13
Deactivation Date:2018-10-05
Deactivation Code:
Reactivation Date:2018-12-13
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty