Basic Information
| Provider Information | |||||||||
| NPI: | 1760559827 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SANCHEZ | ||||||||
| FirstName: | RAFAEL | ||||||||
| MiddleName: | MARIO | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 405827 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303845827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9012274068 | ||||||||
| FaxNumber: | 9012274001 | ||||||||
| Practice Location | |||||||||
| Address1: | 641 RB WILSON DR | ||||||||
| Address2: | SUITE G | ||||||||
| City: | HUNTINGDON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 38344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7319867400 | ||||||||
| FaxNumber: | 7319867402 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2006 | ||||||||
| LastUpdateDate: | 04/24/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | D00000947 | TN | N | Allopathic & Osteopathic Physicians | Family Medicine | 207P00000X | 947 | TN | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | 0947 | TN | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 947 | TN | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | OS5820 | FL | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3733244 | 05 | TN | MEDICAID | P00694510 | 01 | TN | RR MEDICARE | OTHER |