Provider Demographics
NPI:1952183774
Name:LOPEZ, ANTONIO TOMBO JR (NP)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:TOMBO
Last Name:LOPEZ
Suffix:JR
Gender:M
Credentials:NP
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2001 PEACHTREE RD NE STE 645
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1476
Mailing Address - Country:US
Mailing Address - Phone:404-482-9325
Mailing Address - Fax:883-605-2563
Practice Address - Street 1:1412 MILSTEAD AVE NE STE 300
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3877
Practice Address - Country:US
Practice Address - Phone:404-918-2320
Practice Address - Fax:833-605-2563
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-17
Last Update Date:2024-02-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GARN249427207RH0003X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology