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General NPI Number Information
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NPI Number | 1982998977
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Entity Type | Individual
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Provider Name | RICHARD LAWRENCE ANTONIO M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/07/2011
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Last Update Date | 06/06/2025
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Provider Practice Location Address
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Address Line | 250 PARKBROOKE PL STE 300
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City | WOODSTOCK
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State | GA
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Zip | 30189-6401
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Country | US
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Telephone | 770-870-1780
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Fax | 770-928-2601
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Provider Business Mailing Address
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Address Line | 4300 N POINT PKWY STE 300
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City | ALPHARETTA
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State | GA
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Zip | 30022-4102
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Country | US
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Telephone | 770-442-1911
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 74176
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License Number State | GA
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