Provider Demographics
NPI:1669438420
Name:MORILES, ROMEO R (MD)
Entity type:Individual
Prefix:
First Name:ROMEO
Middle Name:R
Last Name:MORILES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ROMEO
Other - Middle Name:RAYA
Other - Last Name:MORILES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:236 ARROWHEAD BLVD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236
Mailing Address - Country:US
Mailing Address - Phone:770-478-9240
Mailing Address - Fax:770-478-0318
Practice Address - Street 1:236 ARROWHEAD BLVD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236
Practice Address - Country:US
Practice Address - Phone:770-478-9240
Practice Address - Fax:770-478-0318
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA039639208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics