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General NPI Number Information
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NPI Number | 1730406778
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Entity Type | Individual
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Provider Name | LERISSA ANN ANTONIO MD
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Gender | Female
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Dates
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Enumeration Date | 04/30/2010
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Last Update Date | 02/01/2023
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Provider Practice Location Address
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Address Line | 5354 REYNOLDS ST STE 424
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City | SAVANNAH
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State | GA
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Zip | 31405-6011
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Country | US
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Telephone | 912-819-8999
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Fax |
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Provider Business Mailing Address
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Address Line | 1 SOUNDING POINT RETREAT
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City | SAVANNAH
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State | GA
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Zip | 31411-2839
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Country | US
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Telephone | 912-272-5549
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 070521
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | ME133162
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 83925
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License Number State | SC
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 70521
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License Number State | GA
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