Provider Demographics
NPI:1740047299
Name:VILORIA, HENRY RODRIGUEZ (MSM)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:RODRIGUEZ
Last Name:VILORIA
Suffix:
Gender:M
Credentials:MSM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5905 NORTHERN DANCER DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-7410
Mailing Address - Country:US
Mailing Address - Phone:770-380-7207
Mailing Address - Fax:
Practice Address - Street 1:5905 NORTHERN DANCER DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-7410
Practice Address - Country:US
Practice Address - Phone:770-380-7207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty