MEDICARE: ANTONIO STITH

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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1649762683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTONIO STITH

Provider Business Mailing Address
First Line	:	2774 AVINGTON LN SE
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-8524
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5215 COLLEY AVE
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23508-2166
Country	:	US
Telephone Number	:	704-650-7927
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2018
Last Update Date	:	06/05/2018

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Directions to “ ANTONIO STITH ” Practice Location

Language	Start Address	Practice Location

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