Iris Castro-Revoredo MD Inc

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

56984 Issued in GA

Legal business name

IRIS CASTRO-REVOREDO MD INC

Practice address

13957 Woolsey Rd
Hampton, GA 30228-2246

Phone

(770) 510-7866

Fax

(770) 603-1122

NPI assigned

May 29, 2012

Organization subpart

No

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

Authorized official

Name

Iris A Castro-Revoredo, MD

Title

Owner

Phone

(770) 510-7866

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1338249600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1338249600000",
    "number": "1588924252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13957 WOOLSEY RD",
            "city": "HAMPTON",
            "state": "GA",
            "postal_code": "302282246",
            "telephone_number": "770-510-7866",
            "fax_number": "770-603-1122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13957 WOOLSEY RD",
            "city": "HAMPTON",
            "state": "GA",
            "postal_code": "302282246",
            "telephone_number": "770-510-7866",
            "fax_number": "770-603-1122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IRIS CASTRO-REVOREDO MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-29",
        "last_updated": "2012-05-29",
        "status": "A",
        "authorized_official_last_name": "CASTRO-REVOREDO",
        "authorized_official_first_name": "IRIS",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-510-7866",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "56984",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Hampton, GA
• Providers in Hampton, GA by specialty
• Internal Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.