Provider Demographics
NPI:1861527103
Name:BASILIO, FLORIDA SELGA (MD)
Entity type:Individual
Prefix:
First Name:FLORIDA
Middle Name:SELGA
Last Name:BASILIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:FLORIDA
Other - Middle Name:FORTES
Other - Last Name:SELGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1519 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-1908
Mailing Address - Country:US
Mailing Address - Phone:706-576-5570
Mailing Address - Fax:706-576-4049
Practice Address - Street 1:1519 13TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-1908
Practice Address - Country:US
Practice Address - Phone:706-576-5570
Practice Address - Fax:706-576-4049
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0287202080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA306087OtherWELLCARE
GA52236043OtherBCBS GA
GA000327137EMedicaid
GA000327137EOtherPEACH STATE HEALTH PLAN
AL60024312OtherBCBS AL