Provider Demographics
NPI:1316621725
Name:HERNANDEZ, JESUS ROSARIO (MD)
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:ROSARIO
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:AUGUSTA UNIVERSITY DPT. OF NEUROLOGY 1120 15TH STREET
Mailing Address - Street 2:1120 ROOM BA 3410
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30912-0001
Mailing Address - Country:US
Mailing Address - Phone:706-721-1990
Mailing Address - Fax:706-721-1962
Practice Address - Street 1:1120 15TH ST.
Practice Address - Street 2:HF 1121
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912
Practice Address - Country:US
Practice Address - Phone:706-721-2148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA148992084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology