Provider Demographics
NPI:1285921171
Name:FERNANDEZ-GERENA, JOSE L (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:L
Last Name:FERNANDEZ-GERENA
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1040 EAGLES LANDING PARKWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-9073
Mailing Address - Country:US
Mailing Address - Phone:770-474-7287
Mailing Address - Fax:770-389-3713
Practice Address - Street 1:1040 EAGLES LANDING PARKWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-9073
Practice Address - Country:US
Practice Address - Phone:770-474-7287
Practice Address - Fax:770-389-3713
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-30
Last Update Date:2020-07-30
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Provider Licenses
StateLicense IDTaxonomies
MI4301099137208600000X
GA075622208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery