Healthcare Provider Details

I. General information

NPI: 1144328717
Provider Name (Legal Business Name): RAFAEL AGUILA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1531 WATSON BLVD
WARNER ROBINS GA
31093-3449
US

IV. Provider business mailing address

PO BOX 117598
ATLANTA GA
30368-7598
US

V. Phone/Fax

Practice location:
  • Phone: 478-918-0770
  • Fax:
Mailing address:
  • Phone: 770-442-1911
  • Fax: 770-442-0306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number25318
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: