MEDICARE: MARIO EURICO RAVRY, M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7387093	OTHER		AETNA

General Provider Information

NPI Number	:	1144294471
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARIO EURICO RAVRY, M.D.

Provider Business Mailing Address
First Line	:	3193 HOWELL MILL RD NW
Second Line	:	SUITE 209
City	:	ATLANTA
State	:	GA
Zip	:	30327-2119
Country	:	US
Telephone Number	:	404-355-4004
Fax Number	:	404-355-4252

Provider Business Practice Location Address
First Line	:	5667 PEACHTREE DUNWOODY RD NE
Second Line	:	SUITE 280
City	:	ATLANTA
State	:	GA
Zip	:	30342-1725
Country	:	US
Telephone Number	:	404-355-4004
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN/OWNER
Name	:	MR. MARIO RAVRY
Credential	:	M.D.
Telephone Number	:	404-355-4004

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	08/22/2020

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