Antonio Luis, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

023759 Issued in GA

Practice address

1013 Fernwood Dr
Ste B
Milledgeville, GA 31061-5428

Phone

(478) 251-6924

Fax

(478) 295-3644

NPI assigned

Apr 7, 2009

Last updated

Oct 10, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Psychiatry

Education

Other, 1979

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Katrina Ransom Clark, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Milledgeville, GA
  • NPI 1376156364
  Medicare reassignment

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Antonio Luis, M.D., LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Milledgeville, GA
  • NPI 1912627126
  NPD
• Hospital Authority of the City of Bainbridge and Decatur County

  dba Memorial Hospital and Manor

  • Multi-Specialty Clinic/Center
  • Bainbridge, GA
  • NPI 1053388256

  Single Specialty

  NPD (past)
• Pineland Area Community Services Board

  dba Pineland BHDD CSB

  • Community/Behavioral Health Agency
  • Statesboro, GA
  • NPI 1588735252

  Single Specialty

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1239062400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570665600000",
    "number": "1093958050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1013 FERNWOOD DR",
            "address_2": "STE B",
            "city": "MILLEDGEVILLE",
            "state": "GA",
            "postal_code": "310615428",
            "telephone_number": "478-251-6924",
            "fax_number": "478-295-3644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1013 FERNWOOD DR",
            "address_2": "STE B",
            "city": "MILLEDGEVILLE",
            "state": "GA",
            "postal_code": "310615428",
            "telephone_number": "478-251-6924",
            "fax_number": "478-295-3644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUIS",
        "first_name": "ANTONIO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-04-07",
        "last_updated": "2019-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "GA",
            "license": "23579",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "GA",
            "license": "023759",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE #",
            "identifier": "023759",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Loving Our Community Counseling Services LLC
• Brittany Monique Lowder, PHARMD
• Douglas L Lowe II, M.D.
• Shannon Adair Lowery, PHARMD
• Kellie Marie Loyd
• Suntana Ly, RN
• Tsimnuj Ly, PHARMD
• Demetrice Lyles Jr., MD
• L. Lynette Lytle, LPC
• Sarah Rose Mack, M.D.

• Psychiatry Physician in Milledgeville, GA
• Providers in Milledgeville, GA by specialty
• Psychiatry Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.