Provider Demographics
NPI:1811040629
Name:REMOLLINO, ANTONIO GARCIA (MD)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:GARCIA
Last Name:REMOLLINO
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 1:1205 US HIGHWAY 19 S
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:GA
Mailing Address - Zip Code:31763-4878
Mailing Address - Country:US
Mailing Address - Phone:229-759-7028
Mailing Address - Fax:229-759-7030
Practice Address - Street 1:1205 US HIGHWAY 19 S
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:GA
Practice Address - Zip Code:31763-4878
Practice Address - Country:US
Practice Address - Phone:229-759-7028
Practice Address - Fax:229-759-7030
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA57994208000000X
ORMD158757208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA806866411EMedicaid