MEDICARE: AMY R CANTILLION MD

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	208100000X	Physical Medicine & Rehabilitation Physician	27319	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00817236	OTHER	SC	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659320695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY R CANTILLION MD

Provider Business Mailing Address
First Line	:	PO BOX 743294
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-3294
Country	:	US
Telephone Number	:	864-255-1920
Fax Number	:	864-679-8766

Provider Business Practice Location Address
First Line	:	317 SAINT FRANCIS DR STE 310
Second Line	:	BON SECOURS PHYSICAL MEDICINE & REHAB
City	:	GREENVILLE
State	:	SC
Zip	:	29601-3968
Country	:	US
Telephone Number	:	864-255-1920
Fax Number	:	864-679-8766

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

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	11/23/2016

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Directions to “ AMY R CANTILLION MD” Practice Location

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