Antonio, Lerissa Ann
Antonio, Lerissa Ann is an individual health care provider with primary practice located at 5354 Reynolds St Ste 424 , Savannah GA 31405-6011. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Hospitalist, Allopathic & Osteopathic Physicians / Internal Medicine. Allopathic & Osteopathic Physicians / Internal Medicine is her primary health care specialty. Antonio, Lerissa Ann can be contacted via phone (912) 819-8999.Contact Information
Primary practice address
5354 Reynolds St Ste 424
Savannah GA 31405-6011
Phone: (912) 819-8999
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Hospitalist | 208M00000X | 070521 | Georgia |
| Allopathic & Osteopathic Physicians / Hospitalist | 208M00000X | ME133162 | Florida |
| Allopathic & Osteopathic Physicians / Hospitalist | 208M00000X | 83925 | South Carolina |
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 70521 | Georgia |
Profile Details
| NPI number | 1730406778 |
|---|---|
| LBN Legal business name | Antonio, Lerissa Ann |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 30th, 2010 |
| Last updated | Feb 1st, 2023 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1730406778 | NPPES |
| South Carolina | Other | SCH508K108 | MEDICARE |
| South Carolina | MEDICAID | 022139100 | MEDICARE |
| South Carolina | Other | JC391Z | MEDICARE |
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