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Fernando Custodio
NPI 1588443022 · on the registry since 2023
Practice
- Address
- 3455 Oak Grove Church Rd
Carrollton, GA 30117 - Phone
- (770) 834-1737
Registry record
- Primary taxonomy
- 225200000X
225200000X
- Licence states on file
- VA
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2023-09-25
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Georgia