Provider Demographics
NPI:1487691580
Name:RIOS, ANTONIO L (CRNA)
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:L
Last Name:RIOS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3260 SPAIN RD
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-8574
Mailing Address - Country:US
Mailing Address - Phone:678-361-3584
Mailing Address - Fax:770-558-3419
Practice Address - Street 1:1 BALTIMORE PL NW STE 400
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2117
Practice Address - Country:US
Practice Address - Phone:404-885-9675
Practice Address - Fax:404-875-4017
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN037456367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1487691580OtherNPI
GAP00201874OtherRR MEDICARE
GA000550459GMedicaid
GAN334027OtherWELLCARE MEDICAID
GA1982637419OtherGROUP NPI
GA000550459EMedicaid
GAP00201874OtherRR MEDICARE
$$$$$$$$$OtherCHAMPUS/TRICARE
GA43ZCCCK03Medicare PIN