Individual ProviderAntonio RiosInternal MedicineAllopathic & Osteopathic PhysiciansPractice Address1315 Jesse Jewell Pkwy NE, Suite 110, Gainesville, GA 30501-3822(770) 219-0023(770) 219-8420PECOS EnrollmentBased on the most recent information from CMS, provider Antonio Rios is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 5 days ago.Profile DetailsProvider ID1629061916Provider TypeIndividualFull NameRios, AntonioTitleDr.CredentialM.D.GenderMaleSole ProprietorNoEnumeration Date8/23/2005Last Updated10/7/2020Contact InformationPractice LocationPractice Address1315 Jesse Jewell Pkwy NE, Suite 110, Gainesville, GA 30501-3822Phone(770) 219-0023Fax(770) 219-0694Mailing LocationMailing AddressPO Box 742616, Atlanta, GA 30374-2616Phone(770) 219-8420FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode207R00000XPrimaryDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicense045114GeorgiaProvider IdentifiersIDDescriptionIssuerID000795473DDescriptionMedicaidIssuerUnlistedGeorgiaID00795473BDescriptionMedicaidIssuerUnlistedGeorgia