Provider Demographics
NPI:1285616029
Name:TOLENTINO, ANITA C (MD)
Entity type:Individual
Prefix:DR
First Name:ANITA
Middle Name:C
Last Name:TOLENTINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MONTROSE DR
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-4239
Mailing Address - Country:US
Mailing Address - Phone:770-474-4552
Mailing Address - Fax:
Practice Address - Street 1:405 ARROWHEAD BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-1254
Practice Address - Country:US
Practice Address - Phone:770-478-9877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA33551207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00443165CMedicaid
GA05BDHDNMedicare ID - Type UnspecifiedANESTHESIA
GA00443165CMedicaid